Moral injury emerged in the healthcare discussion quite recently because of the difficulties and challenges healthcare workers and healthcare systems face in the context of the COVID-19 pandemic. Moral injury involves a deep emotional wound and is unique to those who bear witness to intense human suffering and cruelty. This article aims to synthesise the very limited evidence from empirical studies on moral injury and to discuss a better understanding of the concept of moral injury, its importance in the healthcare context and its relation to the well-known concept of moral distress. A scoping literature review design was used to support the discussion. Systematic literature searches conducted in April 2020 in two electronic databases, PubMed/Medline and PsychInfo, produced 2044 hits but only a handful of empirical papers, from which seven well-focused articles were identified. The concept of moral injury was considered under other concepts as well such as stress of conscience, regrets for ethical situation, moral distress and ethical suffering, guilt without fault, and existential suffering with inflicting pain. Nurses had witnessed these difficult ethical situations when faced with unnecessary patient suffering and a feeling of not doing enough. Some cases of moral distress may turn into moral residue and end in moral injury with time, and in certain circumstances and contexts. The association between these concepts needs further investigation and confirmation through empirical studies; in particular, where to draw the line as to when moral distress turns into moral injury, leading to severe consequences. Given the very limited research on moral injury, discussion of moral injury in the context of the duty to care, for example, in this pandemic settings and similar situations warrants some consideration.
This is the accepted version of the paper.This version of the publication may differ from the final published version.Permanent repository link: https://openaccess.city.ac.uk/id/eprint/23962/ Link to published version: http://dx. AbstractBackground: There is some evidence posttraumatic stress disorder (PTSD) following childbirth may impact on the mother-infant bond. However, the evidence is inconsistent over whether PTSD or co-morbid depressive symptoms are primarily related to impaired bonding.This study therefore aimed to examine the relationship between PTSD symptoms, depressive symptoms and mother-infant bonding. Methods:A cross-sectional online study included 603 mothers of infants aged 1 to 12 months. Measures were taken of PTSD (City Birth Trauma Scale, Ayers et al., 2018) which has two subscales of birth-related PTSD symptoms and general PTSD symptoms; depression (Edinburgh Postnatal Depression Scale, Cox et al., 1987) and mother-infant bonding (Postpartum Bonding Questionnaire, Brockington et al., 2001). Results: Impaired bonding was related to both dimensions of PTSD symptoms and depressive symptoms in bivariate analysis. Path analysis testing the model of whether depressive symptoms mediated the effect of PTSD symptoms on mother-infant bonding found a differential role of birth-related and general PTSD symptoms. Birth-related PTSD symptoms did not have any effect on bonding or depressive symptoms. In contrast, general PTSD symptoms had a direct effect on bonding and an indirect effect on bonding via depressive symptoms. Limitations: Self-report measures of PTSD and depression symptoms were used. Conclusions: Further research regarding different aspects of postpartum PTSD, depression and other disorders in the context of mother-infant bonding are needed. Future preventive programs should focus on diminishing symptoms of postpartum PTSD and depression so that the motherinfant bonding remains optimal.Highlights Both PTSD and depressive symptoms are related to impaired mother-infant bonding. A differential role of birth-related and general PTSD symptoms was found. Birth-related PTSD symptoms did not have effect on bonding or depressive symptoms. General PTSD symptoms had an indirect effect on bonding via depressive symptoms.
Pediatric access to exoskeletons lags far behind that of adults. In this article, we promote inclusiveness in exoskeleton robotics by identifying and addressing challenges and barriers to pediatric access to this potentially life-changing technology. We first present available exoskeleton solutions for upper and lower limbs and note the variability in the absence of these. Next, we query the possible reasons for this variability in access, explicitly focusing on children, who constitute a categorically vulnerable population, and also stand to benefit significantly from the use of this technology at this critical point in their physical and emotional growth. We propose the use of a life-based design approach as a way to address some of the design challenges and offer insights toward a resolution regarding market viability and implementation challenges. We conclude that the development of pediatric exoskeletons that allow for and ensure access to health-enhancing technology is a crucial aspect of the responsible provision of health care to all members of society. For children, the stakes are particularly high, given that this technology, when used at a critical phase of a child’s development, not only holds out the possibility of improving the quality of life but also can improve the long-term health prospects.
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