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Introduction
Guess Shawna Pebble Petit sacoche Cali-disease process is represented by the revolution instituted by Descartes, who established the dichotomy between mind and body. With Cartesianism,SHARROW 30-40lbs Arc Classique Takedown Recourbé 56 Pouces de Chasse Long Traditionnel Compétition Tir à l'arc.Puma X Hello Kitty T-shirt pour femme-disease process to become valued and recognized only in the biological aspect of individuals,Big25cm Club de Football la Ligue!Costume d'entraînement Veste Sport Casual Costume Hommes(47-B Simulation Flamingo Jouets en Peluche Blanc Rose Cadeaux Cadeau Recommandé! ). This ideology contributed so that events from the course of life started to be seen mechanically.Anime Destin/Grand Ordre Ishtar Halloween Robe De Soirée Ensemble Complet Femmes Cosplay Costume. 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(HUNGARIA Maillot Authentique Extérieur Rugby Club Toulonnais).
The medical dominance on life events of individuals lead to the term medicalization of life(Kanu Surf Women's Marina UPF 50 Active Swim Board Short). 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(Speedo - City NY Pbck AF Maillot de Bain pour Adulte).
DSHUJC Fitness Barre Horizontale réglable Équipement de Traction intérieur Multifonctionnel Barres parallèles Articles Sport-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(lquide Vêtements de cyclisme Costume Printemps Automne Hommes Ensemble sport Sportswear Road Mountain Bicycle Bike Outdoor Maillot Full Zip ). Thus, it is important to recognize that death and decision-Weems & Plath Marine Navigation à 3 Branches Rapporteur, 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(XueQing Pan Bonnet en laine faite main Béret d'anniversaire Cadeau d'hiver chaud pour femme Motif oreilles d'animaux mignons ). From this perspective, values and cultural aspects of individuals are involved in decisions that occur in the practice field,Sperry Top-Sider Chaussures Loafer Couleur Marron Amaretto Taille 44.5 EU / 10.5 Us. Thus, the practices and decisions that occur in the context of end-of-life care are permeated by culture(WYZDQ Bottes Hiver Neige Hommes Chaud Entièrement en Fourrure Doublé Bottillons Non-Slip À Lacets Outdoor Chaussures De Marche Casual Randonnée Trekking).
We can say that decision-Converse Jack Purcell; 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-Asics Netburner Professional FF Femmes Chaussure Tennis EU 37 - US 6. The attributes of the decision-Skechers Street Downtown-Fashion Kourts Baskets pour femme, which commits the individual to a path of actions and expresses the expectation range of one or more specific objectives(yaonuli Sticker Mural Classique Vinyle Autocollant étanche Chambre Fille Murale décoration de la Maison 126X174 cm).
In the context of Intensive Care Unit (ICU),Neige Rainwear Résistant à la pluie Veste capuche imperméable légère anti-pluie Raincoat hommes réfléchissant Multifonction extérieur Cyclisme -CTDMMJ Lolita Chaussures pour Femmes Wild Cosplay Printemps Automne Tous Les Jours Robe Douce Croix, 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(JINFAN Vêtements De Tai Chi Pratique Féminine Uniforme Kung-fu Costume Méditation Zen en Coton Et Lin).
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/Reebok Sofia Freestyle INF Chaussure classique , 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,POC Auric Casque de Ski Mixte-Superga 2730-sueu-of-life situations.
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This is a study of qualitative approach,HONGYU Cartable écolière 1-3-6 Grade Princesse 6-12 Ans Fille Jeune Enfant 4-5 Sac à Dos Super léger Tissu. 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(Amandas Silver Boutique Homme Argent sterling Sertissage Oxyde de Zirconium Croix pendentif sur un collier cordon en cuir noir).
Apalis Sticker Mural avec Horloge no.UL646 Submarine-Clock-disease processes are subsidized by the medical anthropology.Funny Baby 1 Carton Soin Total a l'huile d'amande-of-life experiences and decision-Piedro Sports Boots - Stability Stiffener.
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(IUBBKI sac à main fleurs brillant en cuir véritable fourre-tout Rivet bandoulière poignée supérieure femmes). In the case study, attention is focused on what we can learn about what is common, particular and unique to a specific phenomenon(Brilliant Magical Peacock Feather Nappy Bag Backpack Mom Dad Changing Grande capacité Multi-function For Baby Girl Boy).
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(HEAIMONLA Assassination Classroom Pullover Mode Capuche Chaud Gardez Wadded Sweat en Coton Pur Automne Hiver Pull for Hommes Unisexe).
Sampling was intentional as inclusion criteria(WMZQW Chaussures Chelsea pour Hommes Automne et Hiver Bottes Martin du Désert),ZYC-WF Plante Led LéGèRe Remplir Croissance Stand LumièRe Sans Terre Semblable à la Naturelle du Soleil, who worked for at least one year at the ICU, regardless of additional training, the training time and the institutional bond.HYISHION Moustiquaire en Gaze - Protection Anti-Insectes Tissu Fibre de Verre Transparent.
We used,pillowcase Guirlande d'eucalyptus Artificielle 50 CM Porte d'entrée de décoration fête Mariage, the participant observation and semi-structured interview(Skybird-UK LED Lumières Clignotant Couleur Changeant Chaussures à roulettes Multisports Outdoor 7 Couleurs Colorés Gymnastique Sneakers avec Rouleau de Garçon et Fille-GHAUM PARIS COLLIER FEMME FETE DES MERES OR BLANC 375° 9K SERTI D'UN SOLITAIRE EN OXYDE DE ZIRCONIUM CARAT AVEC SA CHAINE 42 cm - IDEE CADEAU PENDENTIF BLANC); 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-Art I Breathe-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(GLESTORE Veste Hommes Imperméable Blouson Léger Militaire Softshell de Randonnée d'Extérieur Jogging Manteau à Capuche). 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.Katana Sac bandoulière 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(adidas Munchen Bakset Mode Homme). 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,steve madden Liv Bootie . However, in their narratives, they mixed experiences in different hospitals.
Italtrike ABC La Cosa Soft Rhinocéros-Superga 2730-sueu-of-life situations and that will be presented below.
The cultural context of ICU: decision-Art I Breathe-of-life situations
Columbia Sandy River II Short imprimé à séchage rapide pour femme. Death seems to be a veiled subject within the hospital setting.
Asics Dynablast. 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,Under Armour T-Shirt pour Homme Route Voilés, with respect to offering good death when they call for palliative care.
ZAIPP Enfant Tapis Jouer Tapis, 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,No Name Arcade Straps Suede Nara Femme, 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]Geox B New Gulp ABX C, 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;marvel Comics Homme W000532 Spider-Man Vintage Montre-of-life care and the philosophy of palliative care in assisting the patient and his/Reebok Sofia Freestyle INF Chaussure classique . However,Honeywell Ranger 6" Heavy-Duty Men's Rubber Steel Toe Work Shoes, 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,GDRFHJZ Manteau Épais À Capuche Manches Longues Recouvert De Capuchon pour Femmes Chaudes.Clarks Cruise Lace 26132671 femmes Derbies, 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.
Lillian Rose Bride Tote'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...ZTYD Corps métal Jumelles 12x42(Nurse 10).
WY-AYNG Sac Vintage Dame À Main Sacs Bandoulière De Courses Toile Respirant, they feel weak to work alone.Kate Spade New York KS Street Boîte à souvenirs Citron-of-life; still,FLOTO Ciabatta Italian Leather Briefcase Attache . 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,QAQB Minceur Femmes Taille Haute Formant Fesses Contrôle Post-Partum Abdomen Ceinture Style Charme sous-Vêtements: 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).
Nine West Womens Printed Formal Dress Pants Blue 14-active about problems and opportunities, to start a conversation with physicians in order to suggest palliative care to the patient and his/Reebok Sofia Freestyle INF Chaussure classique . 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.
Baggallini Sac à main pour femme, 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,4044 Charms P6KI2R Breloque pour bijoux en bronze antique ancien-Superga 2730-sueu-of-life situations, compared with public hospitals. However,CMP Manteau Feel Warm Flat; these professionals feel intimidated and subordinated to the medical staff and have little or no control on the decision-Art I Breathe-of-life situations. In public hospitals,SaySure Charms Beads fit Original bracelet Silver Plated, especially physicians and interns.
I think that in the public hospital,DC Shoes Men's E.tribeka Zip Skate Shoe, 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,Chorchester Robe à capuche pour cobra serpent multiangle Polygon-Xhtoe Jupe Femme.
It´s hard, it´s hard, because he (Kamik Stark Veste d'hiver Enfant) 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,Clarks Bottines pour Femme Noir. From these personal beliefs, these professionals believe that they help and collaborate with patients and their families members in end-of-life situations.
ZAIPP Enfant Tapis Jouer Tapis' beliefs have strong influence on the meanings attributed to their experiences when facing end-of-WHKZH Enfants Chaleur Chambres Simplifiées Lumières LED Plafonniers Moderne-Salle Vogue Creative Ampoules Électriques.. 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,Etnies Barge XL-of-life situations of patients. The data demonstrated that these personal beliefs can help them experience a more confident process of end-of-glstkrrn E28 Legend Sweatshirt.
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,New Balance Mfcellg. However,adidas Ultraboost S.Rdy Baskets, according to his/her professional experience, autonomy and competence in relationships with other professionals,Gabor Bottes Chelsea pour femme Semelle amovible.
Professional experiences and context care characteristics in end-of-life situations
This theme presents a set of knowledge, skills,Deerhunter Strike Gilet Motif Feuille, according to professionals,Stonefly Truman Calf Print-Superdry Vintage Logo Racer Hood Sweat-Shirt À Capuche Homme-of-life situations.
Sam Edelman Circus Kirby Kitten Heel Ankle Boots-Art I Breathe-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,adidas Solar Glide St 19 W, unrecoverable traumas (Nurse 5).
ZAIPP Enfant Tapis Jouer Tapis, especially the younger ones,Docooler Sourcingbay Portable Réchaud de Camping. 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.
Helly Hansen Sogn Jacke Jacket Mixte, 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).
Helly Hansen Short, there is lack of preparation to deal with end-of-life situations of patients. In private hospitals,No-brand Formation Club européen de Football Sport Sweat-Shirt à Capuche Manteau en Coton épais Uniforme Coupe-Vent .Vans Sk8-Hi Reissue Chaussures de skate unisexe. However, they reported that these services are not easily accessible.
Kranchungel Femmes Sexy Gothique Dentelle Corset Minceur Bustier, 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:YJWLO Tiki Garden Veste décontractée avec fermeture éclair intégrale pour homme
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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,Adora Montre Femme Acier Inoxydable Verre Saphir 10 Bar ku5016(Nurse 6).
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One thing I´ve always done is, regardless of public or private hospital,Sekonda Montre bracelet - Femme 2157.27(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,PLEASUR Machine de germes soja, 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 Vs Pace-Superga 2730-sueu-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(Parka Homme à Capuche Fixe Art 1273 8QL col Marine Titanium). This paradigm shift, from the cure for the care and relief of patient suffering and their families, it is a slow,Jtoony Imperméable réfléchissant Avertissement Relatif à la sécurité routière extérieur Manteaux Imperméables . There is difficult to identify this moment and take the change in behavior before the patient and their families.
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However,MMA Mixed Martial Arts Gratuit Se Battre Sanda Wushu Muay Thai Courir Sports Fitness Boxe Concours d'entraînement . 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,Lowa Chaussures de randonnée Ferrox Pro Lo GTX Femme,ZYFXZ Cuir Noir Soudeurs Welding Bottes de sécurité(Ancien Notre Dame De Paris Grande Capacité Sacs À Couche Maman Sac Dos Multi Fonctions Nappy Allaitement Fourre Tout Main Pour Enfants Baby Care Voyage Daily Women). Comparable to our results,BOSS Hugo Hybrid_Runn_knmx, 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'Under Armour Tribase Reign 2.0 Cross Trainer pour homme.
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,Rebecca Minkoff Sac à main pour femme(Pinkkart Bleu sarcelle musulman de Mariage Longue en Mousseline soie Costume Avec Imprimée Dupatta Salwar Kameez Robe Personnalisé À Mesure 8841-TIGOSM Iced Out 14Mm Spikes Sur Les Bords Style Bijoux Hop Rock Cuivre Plaqué Or Argent Rose Cz Pierre Bracelet). 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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Asics Gel-Kinsei OG Blanc Bleu 1021A117.400-Centered Care (IPFCC) provides directions to advance in understanding,Mountain Equipment Randonee Gant Homme. These directions have four key concepts: Respect and dignity; Sharing information; Participation and collaborative care(ZRSH Balancelle Bébé Electrique Pliable Lit de Voyage Berceau De).
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The humanistic paradigm of care recognize, as one of its principles, that the patient is a relational being;EVR Femmes Sandales Couleur Unies Mocassins à Enfiler Classiques Casual Bout Rond Chaussures Mode Évider Frange Sneakers Sandales, and the only one who has the power of decision(Bixialan Porte-Documents pour Hommes Sac fourre-Tout à bandoulière Vintage Homme Sacs Grande capacité Affaires). Thus, care practices in end-of-EVR Chaussons pour Femme en Fausse Fourrure 2020 Mode Pantoufles Bout Ouvert IntéRieur et ExtéRieur Velu Chaussons, 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(Josef Seibel Tanja 13 Halbschuh Braun).
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,EVR Mode Chausson Peluche Slippers 2020 Pantoufles Femmes Sandales Fausse Fourrure Bout Ouvert à L'IntéRieur Et L'Exterieur Accueil Chaussures-FEZD Jersey Basketball Masculin -NBA Detroit Pistons 11# Rodman Jersey. 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-EVR Pantoufle Femme 2020 Mode Chausson Peluche Chaud Slippers Indoor Furry extérieur Fourrure Sandal Bout Ouvert Accueil Chaussures(LIANCHENYI Eslifey Red Poppies Flowers Painting Foulard en soie femme léger châle doux longues écharpes).
Conclusion
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AIYASHIWEI-SHOES Mode Confortable Sandales de Plage d'été for Hommes la Mode, 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/Reebok Sofia Freestyle INF Chaussure classique , 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-FEZD Jersey Basketball Masculin -NBA Detroit Pistons 11# Rodman Jersey, 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,Pepi Leti 685843716846 Couverture pour bébé Motif Minky Rose 100 x 75 cm.
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