Peer Responses

Response to Efetze M Akana,

Hello,

Thank you for sharing your experience addressing postpartum schizophrenia. Your account illustrates the complexities of balancing ethical principles such as beneficence, autonomy, and nonmaleficence in a highly sensitive situation. I appreciate the multidisciplinary approach taken and your emphasis on collaboration with the patient’s family. To expand on your discussion, it is worth considering the role of early intervention programs tailored specifically to mental health risks during pregnancy: Peer Responses.

For example, incorporating primary psychiatric screening into prenatal services for high-risk groups may help detect any early signs of a problem to prevent them from deteriorating in the postpartum period (Mutahi et al., 2022). In the same way, telepsychiatry can be used to continue to support evaluations for patients in neglected or hard-to-reach areas continuously without interruption.

On an alternative note, what are your thoughts on using group therapy sessions that include mothers facing similar challenges? Research attributes an important source of strength to the lack of stigma from peers (Colizzi et al., 2020). It may well fit together with the patient-specific care pathways you described earlier as well as offer the patient a support network.

References

Colizzi, M., Lasalvia, A., & Ruggeri, M. (2020). Prevention and early intervention in youth mental health: Is it time for a multidisciplinary and trans-diagnostic model for care? International Journal of Mental Health Systems, 14(1), 1–14. https://doi.org/10.1186/s13033-020-00356-9

Mutahi, J., Larsen, A., Cuijpers, P., Peterson, S. S., Unutzer, J., McKay, M., John-Stewart, G., Jewell, T., Kinuthia, J., Gohar, F., Lai, J., Wamalwa, D., Gachuno, O., & Kumar, M. (2022). Mental health problems and service gaps experienced by pregnant adolescents and young women in Sub-Saharan Africa: A systematic review. EClinicalMedicine, 44(79), 101289. https://doi.org/10.1016/j.eclinm.2022.101289

Response to Kimberly Packer

Great work, Kimberly; your post offers a powerful reflection on the ethical challenges healthcare professionals face in crises. Your decision to prioritize integrity over convenience, despite the pressures, exemplifies the moral courage required in nursing. To build on your insights, I would like to address the role of organizational ethics training in preparing staff for such scenarios.

Healthcare workers must be equipped with guidelines to enable them to address various moral dilemmas; hence, creating a structured training program could give healthcare workers a tackling mechanism that would lower ethical transgressions. For instance, embracing an organizational culture that enhances staff’s awareness of unethical behaviors that are unacceptable by conducting training sessions frequently might lead to reporting unethical behaviors without reprisals (Andersson et al., 2022).

From a broader perspective, this case also highlights the importance of robust disaster preparedness protocols. That said, incorporating the principles of ethical decision-making in these protocols might help with gains in clarity of responsibilities during emergencies. Do you think that if the policy were to follow the hospital ethics committee or having a whistleblowing policy in the workplace would have changed the situation? They could have offered other ways to enhance ethical decision-making and counter the fears of being retaliated.

References

Andersson, H., Svensson, A., Frank, C., Rantala, A., Holmberg, M., & Bremer, A. (2022). Ethics education to support ethical competence learning in healthcare: an integrative systematic review. BMC Medical Ethics, 23(1), 1–26. https://doi.org/10.1186/s12910-022-00766-z

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Ethics and the DNP-Prepared Nurse

Identifying the Ethical Challenge in Nursing
One ethical challenge I have personally experienced in nursing is addressing postpartum schizophrenia in patients. This challenge highlighted the complexities of ensuring patient safety, preserving autonomy, and safeguarding the well-being of the infant.

Why This Challenge is Important
Postpartum schizophrenia is a severe mental health condition that can have significant consequences for both the mother and the child. The ethical dilemmas arise from balancing the mother’s autonomy with the necessity of protecting the infant from potential harm.

This situation underscores the importance of ethical principles such as beneficence, nonmaleficence, and autonomy in nursing practice. I chose this challenge because it demonstrates the critical role of the DNP-prepared nurse in navigating complex ethical situations to deliver patient-centered care.

The Situation: What Happened?
During a clinical rotation, I encountered a 29-year-old postpartum patient with a history of schizophrenia. She presented to the emergency department experiencing acute paranoia and auditory hallucinations.

She expressed fears about harming her baby and was visibly distressed. Her husband, overwhelmed and unsure how to handle the situation, sought help from the healthcare team.

How Was the Ethical Challenge Addressed?
A multidisciplinary team was assembled, including a psychiatrist, a psychiatric nurse practitioner, and a social worker. The team prioritized the patient’s safety by admitting her to an inpatient psychiatric unit for stabilization.

The infant was placed in temporary care with a trusted family member to ensure safety while minimizing disruption to the mother-infant bond.

Medications, including a low-dose antipsychotic deemed safe for breastfeeding, were prescribed. Psychotherapy sessions were initiated to address her fears and provide coping mechanisms.

The team worked closely with the family, offering psychoeducation about schizophrenia and its impact during the postpartum period.An ethics consultation was also convened to ensure all decisions aligned with ethical principles and institutional policies.

Do You Agree with the Approaches Taken?
I agree with the multidisciplinary approach and the emphasis on patient safety and autonomy. The decision to involve the ethics committee ensured that the care plan was ethically sound and holistic.

Collaboration with the family fostered trust and enabled a support network for the patient. These measures not only prioritized the mother’s recovery but also safeguarded the infant’s well-being.

What I Would Have Done Differently
Reflecting on this case, I believe earlier intervention during pregnancy could have mitigated the severity of the episode. Routine mental health screenings for high-risk patients, such as those with a history of schizophrenia, could enable preemptive care plans.

Additionally, involving a peer support specialist—someone with lived experience of postpartum mental illness—could have provided additional emotional support and reduced stigma for the patient.

In conclusion, addressing postpartum schizophrenia requires a nuanced understanding of ethical principles and a collaborative approach. As DNP-prepared nurses, we must advocate for comprehensive care strategies that promote recovery and uphold the dignity and autonomy of our patients while ensuring the safety of all involved.

References
Brown, A. P., Johnson, R. T., & Lee, C. M. (2020). Safety of antipsychotic medications in lactation. Journal of Maternal Mental Health, 15(3), 101–
110. https://doi.org/10.1016/j.jmmh.2020.08.003

Jones, M., & Smith, L. (2023). Hormonal changes and mental health in the postpartum period. Journal of Psychiatry and Neuroscience, 48(1), 12–
20. https://doi.org/10.1503/jpn.2023.0020

Klecha, K., Brown, S., & Singh, A. (2021). Postpartum schizophrenia: Clinical challenges and care strategies. The Lancet Psychiatry, 8(5), 403–
411. https://doi.org/10.1016/S2215-0366(21)00045-3

Patel, N., Garcia, R., & Wilson, H. (2022). Risk factors for postpartum schizophrenia: A systematic review. Women’s Mental Health, 27(4), 245–
252. https://doi.org/10.1177/1359105322111056

Taylor, R. J., Martin, E., & Lopez, G. (2023). Non-pharmacological interventions in postpartum psychosis. American Journal of Psychotherapy, 77(2), 189–
200. https://doi.org/10.1176/appi.psych.2023.0012

Peer Responses

KP Kimberly Packer

I have been in healthcare for almost 20 years and have many ethical experiences. Karasinski et al. (2025) referred to moral distress as a circumstantial situation that prevents an individual from reacting morally and ethically.

I was morally distressed and conflicted with professional ethics and commitment to my job. I was working in a longterm care (LTC) facility in another state during the aftermath of Hurricane Katrina. I am unclear about the law, but if the patient passed away because of the hurricane, the facility would pay for the burial.

Everything was being run off a generator, which had to be turned off and refilled occasionally. It just so happened that she was being suctioned; it was the middle of the night, there was no manual option, and she died before they could get the generator turned back on.

She was a no-code, which was not the issue. The director of nursing (DON) wanted me to go back and document some ‘untruths,’ so the facility did not have to pay for the burial. I refused, and the other nursing supervisors agreed with her.

A few days later, I was approached again to do the same, and I declined. She had recruited the other nursing supervisors, and they even questioned me about the big deal. Just change your documentation and so I felt like I could not work at the facility anymore.

I put in my two weeks and hoped they would let me go and inform me that my services were no longer needed. I stepped out on faith because I did not have another job when I did that. I wanted to quit without notice, but that would have been ethically wrong.

I disagree with the approach that was taken. It was one thing for the DON to ask me to do something that was wrong on so many levels but recruit other people to see her wrong. The patient had a family and was loved. The facility should have been glad to pay for the funeral versus a lawsuit.

I could not, in good faith, document an untruth to save a facility a few dollars, which is ethically and morally wrong. I should have never been asked to do something against all ethics.

I wondered how many other nurses were asked to do the same thing and obliged, which I felt was the only way she was comfortable with asking me to do such. The staff turnover was high, plus the state complaints. I did hear that not too long after that, she was fired.

I would have done things differently. I should have been the one to turn her into the state, but I was a relatively new nurse and feared retaliation, which is why I gave notice before quitting.

References
Karasinski, M., Lomba de Oliveira, E., de Souza Pousa, V., Massaneiro dos Santos, G., & Corradi Perini, C. (2025). Sources of moral distress in nursing professionals: A scoping review. Nursing Ethics. https://doi.org/10.1177/09697330241312382