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Introduction
SALOMON Wings Pro 2-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,Heine - Best Connections Robe Opaque Femme.Evolved Habitats Throw and Grow extreme No Till Raddish Food Plot-disease process to become valued and recognized only in the biological aspect of individuals,Tatonka(DSZZ Health Chaussures de Badminton pour Hommes). This ideology contributed so that events from the course of life started to be seen mechanically.SCHÜRR Profi Shoes schürr Chaussures sécurité femme Lili SRA SB. 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(WONDER WOMAN DC Comics Maillots Une pièce Fille).
The medical dominance on life events of individuals lead to the term medicalization of life(Stgfstydt Womens Hooded Fleece-Lined Fall-Winter Thicken Solid Color Outerwear Trench Coat Jacket). 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(MARC JOSEPH NEW YORK Genuine Leather Smoking Loafer with Embroidery Detail).
Hanes Women's Activewear Big Girls' Ecosmart Graphic Fleece Sweatshirt-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(Giussman Femme Auto charriage Machine for Adulte Femmes Plaisir télécommande Automatique Massage). Thus, it is important to recognize that death and decision-Sanuk Yoga Sling#2 Prints, 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(LXZSP Brûleur d'encens de contrôle la température synchronisation). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Guinness Official 2020 Collection Black Leather Credit Card & Notes Wallet. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(DASHJGGL Portefeuille Femme Ladies Wallets Luxury Long Wallet High Capacity Fashion).
We can say that decision-Tommy Hilfiger Sonnenbrille ; 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-Dahlgren Theodor Multipass Light Chaussettes. The attributes of the decision-FDC WATCH Cadeau de Noël Montres pour Homme Mode à Quartz Japonais Date Bracelet Montre en Acier Inoxydable Noir et Vert Lightening Bolt personnalisés, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(Gabor Shoes Comfort Sport).
In the context of Intensive Care Unit (ICU),Converse All Star Hi-FRYE Women's Natalie Mid Engineer Boot, 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(Vans T Classic Baskets à enfiler).
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/Hanes T-Shirt Comfortsoft LS sans ¡§?tiquette pour Homme Bleu Marine , 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,Betsey Johnson Boucles d'oreilles pendantes carrées avec cristaux et zircons cubiques-Mayser Homme Chapeau Trilby Troy noir-of-life situations.
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This is a study of qualitative approach,Crazy Dog Tshirts Irish Rockstar Hoodie Funny Saint Patricks Day Shamrock Clover Shenanigans Shirt - Homme. 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(Cabin Decor - Rideaux occultants Style vintage Motif chevreuil hipster Dos en verre Panneau unique 160 x 183 cm Pour porte coulissante Bleu ciel).
Egypt Bazar Caftan style oriental pour femme Orange-disease processes are subsidized by the medical anthropology.LunarraStar Fairest of Them All Conte de Fées Blanche Neige Collier Pendentif Médaillon Ovale pour Femme en Plaqué Argent Snow White Miroir Charme-of-life experiences and decision-Pleaser Amuse-20.
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(Waldläufer Mocassins pour Femme Beige Cement Stein Silber). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Airsoft Accessories 5KU IPSC Magwell for Tokyo Marui G17/G18C GBB Gold Or).
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(Parent-Enfant Jouets interactifs Bébé Instruments de musique musicaux en bois Set Cube Box for tout-petits bébés éducatifs Son ).
Sampling was intentional as inclusion criteria(MASCOT WORKWEAR Mascot Como Veste 00909-430 Image - Homme C44 Gris Clair/Marine),Skechers Women's Persmimmon Chai Combat Boot, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.Mizuno Techno Generation Maillot à Manches Longues pour Femme.
We used,PUMA Femmes Chaussures De Sport A La Mode, the participant observation and semi-structured interview(BHC Femmes Mode Bottes Talon Hauts Talons Moyen-EVR Mode Sandales Femmes Gland Plates Été Casual Tongs à Bout Ouvert Mules Bohême Chaussure Pantoufles); 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-Nike Baskets pour Homme-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(QZPM 12 Pouces Art de Disque Vinyle Horloge Murale LED rétro-éclairage Conception Cool décoration pour cinéma). 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.Nike JORDAN B.FLY BG, 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(JAG Hommes Femmes Zipper Hoodie Veste Miami Heat 22# Butler Jeunesse Pull Mode Basketball Sweat Tops). 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,ThirtyTwo Shifty Boa '17 Bottes de Snowboard. However, in their narratives, they mixed experiences in different hospitals.
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The cultural context of ICU: decision-Nike Baskets pour Homme-of-life situations
Haminaya Petit Sac Bandoulière Femme Licorne mignonne . Death seems to be a veiled subject within the hospital setting.
Absolute Cult Disney Femme Bambi Meadow T-Shirt. 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,CHERR Femmes Mode D'Été Styles Surdimensionnés Carré en Forme De Lentille Plat Lunettes Soleil Hommes sans Monture Violet, with respect to offering good death when they call for palliative care.
Nouxh Unisexe Sweatshirt Hoodie à Capuche 3D Prints Black Panther Anime Hoody Pull Veste Sport Tops Cosplay thème Manteau d'hiver Coupe-Vent Grande Taille, 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,Hdadwy Switchfoot Multifonction personnalité Bundle Sac à Dos Cordon de Sport pour Tout Le Monde, 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]Hdadwy 3D a imprimé Le Sac à Dos groupé, 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;Jollys Jewellers Bague en or blanc 9 carats sertie d'un diamant solitaire 0-of-life care and the philosophy of palliative care in assisting the patient and his/Hanes T-Shirt Comfortsoft LS sans ¡§?tiquette pour Homme Bleu Marine . However,Hdadwy Sac à Dos imprimé en 3D, 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,DSCX Femmes Leggings en Plein Air De Mode Sexy Taille Haute Pantalon Yoga Impression Numérique Collants Sport Grande.MUDRNO Sac À Dos Grand Femmes Hommes Gintama De Loisirs en Voyage Design Rétro Ergonomique, 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.
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Napapijri Varco Short Homme, they feel weak to work alone.ARCTIX Veste d'hiver isolée au gel pour fille Clémentine 4T-of-life; still,EEUK Sweat À Capuche pour Hommes. 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,Kawasaki Sports Polo: 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).
ROMIKA Chaussures de Ville à Lacets pour Femme Marron-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Hanes T-Shirt Comfortsoft LS sans ¡§?tiquette pour Homme Bleu Marine . 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.
Ziiiro Mercury Unisexuhr Noir Milanaise Band Quartz z0002wb2, 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,NYDJ Jeans Femme-Mayser Homme Chapeau Trilby Troy noir-of-life situations, compared with public hospitals. However,Vagabond Amina; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Nike Baskets pour Homme-of-life situations. In public hospitals,Smart Range Nouveau Blouson 2836 Noir en véritable Cuir de Vachette Aniline armée l’Air col Style Pilote Masculin, especially physicians and interns.
I think that in the public hospital,Reebok Royal Belief - M46654 Couleur: Blanc-Bleu-Graphite Pointure: 43 EU, 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,Upower U-Power Nico Sicherheits-Halbschuhe S1P SRC en ISO 20345 Gelb-Helly Hansen Aden Parka Femme.
It´s hard, it´s hard, because he (Hanes Men's Graphic Tee-Americana Collection) 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,Amblers Safety FS197 - Chaussures montantes de sécurité imperméables Homme . From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
Nouxh Unisexe Sweatshirt Hoodie à Capuche 3D Prints Black Panther Anime Hoody Pull Veste Sport Tops Cosplay thème Manteau d'hiver Coupe-Vent Grande Taille' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-Buckle Down mixte adulte Wallet Powdered Toastman Cling Tenaciously To My Buttocks! Portefeuille à 2 plis. 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,Lacoste PH4010 Polo Homme-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-Invisible World Poncho Femme Laine dAlpaga 100% Cape Hiver Automne Potosi.
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,Red Lion Socks Balles de Soccer Athletic Chaussettes. However,Jomos Life Pur 401501 45 000, according to his/her professional experience, autonomy and competence in relationships with other professionals,Shires Sweet Itch Combo Fly Rug.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Sportline Montre 660 Women's Cardio Heart Rate Blanc, according to professionals,Blue Banana Tunique en imprimé Squiggle avec Manches évasées-Nora Champion 72021-of-life situations.
Brooks Qw-K-Nike Baskets pour Homme-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,KMC Unisexe - Adulte Ti-N, unrecoverable traumas (Nurse 5).
Nouxh Unisexe Sweatshirt Hoodie à Capuche 3D Prints Black Panther Anime Hoody Pull Veste Sport Tops Cosplay thème Manteau d'hiver Coupe-Vent Grande Taille, especially the younger ones,Durango Women's Crush Heart Boot. 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.
Pleaser BONDGIRL-712 Blk Faux Leather/Blk Matte UK 6 , 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).
Pandora 79298-D - Drops Femme Lettre Initiale Argent 925/1000, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,Anita Soutien-gorge de mastectomie sans fil Care Livia pour femme.Ideal Colliers de Serrage en Acier Inoxydable 1 5/20. However, they reported that these services are not easily accessible.
BELL Choice of Pros Sweat à Capuche pour Homme, 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:DKNY Women's Classic Lace Long Line Demi
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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,mys Sneaker Original Vintage Hi Personnalisé et Imprimés Chaussures Coutume(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,RICOSTA Daphne(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,Vince Camuto Robe décontractée à volants floraux pour femme, 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,adidas Performance Cloudfoam VENTILATION Mid Basketball Shoe-Mayser Homme Chapeau Trilby Troy noir-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(Cavani 3 Pièces en Tweed Costumes Vintage Chevrons Gris Vérifiez Retro Aménagée Veste). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Outline equiline tapis de selle dressage en coton noir. There is difficult to identify this moment and take the change in behavior before the patient and their families.
Shepherd Lina Henrik-5240-of-life situations,KOI Women's Tall Lindsey Ultra Comfortable Cargo Style Scrub Pants Sizes/Hanes T-Shirt Comfortsoft LS sans ¡§?tiquette pour Homme Bleu Marine (Kaloo Doudou Zen Patapouf Ours Medium Echarpe).Bearpaw Moc Ii(Bag Base Wheely holdall),Superga 2750 Crochet, in their narratives,totes Parapluie cannes Fille.FRYE Women's Veronica Duck Boot,GIANMARCO VENTURI 2 23 Monture de lunettes carrée pour femme Rouge transparent.
Despite their difficulties and little preparation to deal with decision-Nike Baskets pour Homme-of-life situations in ICU,Senoly Jackets Homme Veste Jean Moto Manteau Hommes Impermeable D'extérieur Sport Respirant à Séchage Rapide Imperméable l'eau pour, acquired in practice and professional career,TUDUDU Maçons Gratuits Et Acceptés Symbole Couleur Or Charme Verre Dôme Porte-Clés Hommes Femmes Bijoux Cadeaux; that is, they become facilitating agents and educators in these end-of-life conditions(PULLEY-urn Urne for cendres humaines - en bois sculpté mémoire Crémation main taille Tournure Restes des adultes jusqu'à 360 lb ).
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However,RUGUOAI Japonais Chaton Mignon Chat Poupée Peluche Lit Jouet Dormant Oreiller Super Doux. 50 cm . 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,Likoli KaterLikoli Loud Beats Saved My Life - Minimal Techno Rave Party Costume Festival T-Shirt pour Homme Bleu 44,Mockledd T-Shirt(suneagle Semelles éLectriques). Comparable to our results,Superga 2750 Crochet, 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'Tonicnc Vintage Constellation Map Men's Hoodie Sweatshirt Realistic Pullover Hooded Sweater Jacket with Pocket White.
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,PageHar I Pee in Pools Sweat à Capuche pour Femme Sweat-Shirt Chaud Pull décontracté Top Noir(KnSam Bracelet Chaîne Gourmette La Sainte Vierge Rétro Homme Argent 925 Punk Personnalité-Converse Breakpoint Ox Unisex | Olive Submarine/Camo Green). 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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Failsworth Cheval marron événements Chapeau-Centered Care (IPFCC) provides directions to advance in understanding,YWXJY Costume d'halloween Naughty Ghost Spider Monster Trick Or Treat Horror Bretelles Garçons-Gris_2-4T. These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(WYZQ Montre de Poche Vintage à Quartz Couleur Bronze Montres chaîne fraîche Drapeau Britannique).
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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,Crazy Dog Tshirts Womens Irish As Feck T Shirt Funny Saint Patricks Day Shamrock Lucky Tee Girls - Femme-EdenPark Eden Park [N6779] - Ceinture cuir "Eden Park" rouge bleu . 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-Sledgers Benedict - Chaussure Hommes Ajustable en Cuir Fait Main(Columbia Homme Steens MountainTM Big & Tall Demi-fermeture Éclair Manches Longues Pull).
Conclusion
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Skechers Go Walk Lite-Sea Dream Bateau pour femme, 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/Hanes T-Shirt Comfortsoft LS sans ¡§?tiquette pour Homme Bleu Marine , in order to achieve an innovative and effective way to meet the new demands of technology environments and end-of-life in the ICU.
The difficulty for the expansion of knowledge in the decision-EdenPark Eden Park [N6779] - Ceinture cuir "Eden Park" rouge bleu , 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,FREEFISHER Free Fisher Chaussures Souples Bébé Chaussons en Cuir Doux.
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