Electroconvulsive Therapy: Thoughts for Nursing

Despite controversial points-of-view aboutelectroconvulsive therapy (ECT) and the stigma attached, it is an evidence-based treatment shown to be very effective in its application, for the treatment of various psychiatric disorders. It is most commonly used to treat individuals diagnosed with major depressive disorder (MDD) who have failed to adequately respond to other forms of treatment such as medications (Husain & McClintock, 2011; Weiner & Falcone, 2011). ECT has also demonstrated effectiveness in the treatment of conditions such as catatonia and other mood disorders including those that present with psychotic features (Kavanagh & McLoughlin, 2009). In severe cases, in which individuals are expressing suicidal thoughts or behaviors, or harm towards others, ECT is often recommended as the most appropriate form of treatment due to its rapid response rate which helps to ensure one's safety (Weiner & Falcone, 2011). In order for effective care to begin nurses must have a fundamental understanding of ECT. However, even before learning about ECT, one must identify biases that may affect their potential to gain knowledge of this treatment modality (Martin, 2013). Time and again I hear many peoplesay “ECT?Theystilldothat?”or “Wow,that’sbarbaric.”Thisoften presents an opportunity to discuss ECT and the advancement of its use. ECT is expressed as a shock for many. It seems to create a stir of emotions not only among patients, but also among nurses and staff colleagues. The closest I had come to learning about ECT, prior to my professional experience as a mental health nurse, was in the popular film One Flew Over the Cuckoo’s Nest starring Jack Nicholson. The movie depicted ECT as horrific and torturous. From this experience I developed negative biases about this form of treatment. But for me, this became a motivation for learning more about ECT and taking responsibility for addressing biases in order to be an effective mental health practitioner. As a new graduate nurse working at a psychiatric hospital I had the opportunity to observe a patient receiving ECT. In the treatment area I remember seeing a nurse, a psychiatrist and a resident observing a psychiatrist, and an anesthesiologist. I also noticed the patient lying supine on the hospital gurney. He was notably restless, appearing to be anxious to get the treatment started. In the recovery area awaited another nurse who would receive the patient and provide care immediately after the procedure. Of note, both nurses had skills and knowledge in their respective clinical area of the ECT suite to provide care to the patient during and after the procedure. Throughout my clinical experience working on inpatient psychiatric unitsIrealizethatfewnursesarefamiliarwiththepre-andpost-nursing care of patients receiving ECT. There are nurses with whom I worked who have some knowledge, but are not familiar with the clinical and/or physiological processes involved in ECT to the extent appreciable to the care of patients before, during, and after ECT treatment. I find this to be an insult to direct nursing care and clinical support to the patient. Mental health nurses have a responsibility of understanding all aspects of care as it applies to their clinical area and scope of practice. Ongoing clinical education of pertinent healthcare information based on the latest evidence to other professionals, consumers of care and the public is also expected. This helps to clarify confusion that can be false and/or misleading (Martin, 2013). Having the experience of working as an ECT nurse coordinator it is my strong belief that mental health nurses be educated beyond a brief orientation upon hire to assist in the administration of ECT and the patient care processes before and after treatment. Education should then be continued at regular intervals to keep mental health nurses abreast of their skills and knowledge of ECT nursing care. Structured and formalized organizational efforts to standardize ECT education for mental health nurses and other health care professionals would help increase awareness and knowledge, and thereby decrease stigma and biases associated with this treatment modality (Patry et al., 2013). Yet, nurses have said to me “it’s like an operating room I’d rather be on the floor, ”“ I want to talk to my patients and do psychotherapy I can’ td o that in ECT,” and “I don’t want to do ECT.” While the care of the patient undergoing ECT is very different from working on the floor it becomes otherwise a disservice in many ways to patients when nurses opt out of working with patients undergoing ECT or learning about it for the purposes of extending care beyond the ECT treatment area. Mental health nurses who are well informed about ECT offer implications for patient safety, quality of care, patient care directives, and assessment criteria well after patients have received ECT.