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Sarah Lincoln
Professor Williams-Barnard
NURS 616C
December 1, 2013

Electroconvulsive Therapy in the Mental Health Setting
The Issue
Electroconvulsive therapy (ECT) is an intervention used in the mental health
setting for clients suffering from major depressive disorder, acute manic episodes, or
schizoaffective disorder. Although it is unknown exactly how ECT works to help people
with these disorders, we do know that it may alter the neurotransmitters in the brain that
are affected with these disorders by stimulating the brain and causing a seizure. The
client is under anesthesia during this procedure while a professional doctor stimulates the
seizure, monitoring the clients response and analyzing its effects. Previously, ECT has
been looked at as a cruel procedure. This research paper discusses the ways in which
ECT can positively impact a client and his or her families who suffer from a mental
illness.
There is a stigma related to ECT in the general public. The media, along with
individual opinions, have made this therapy seem negative and inhumane. Van and
Gallagher state, the fear placed some blame on the publics association of electric
shocks with execution and torture, and also to the fear of losing self-control under
anesthesia and the unsightly appearance of a grand mal seizure. Understanding the
effectiveness and proving the many myths associated with ECT to be false is essential in
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order to understand the full effect of ECT. One must explore the opinions of individuals
who have experienced the treatment in which I was granted the opportunity to.
The Rationale
I was allowed the opportunity to join a client from the hospital to one of his ECT
sessions. The client I accompanied to this treatment was diagnosed with major
depression and had previously had a suicide attempt. This client stated that his
medications he had been taking for years were not helping his illness. The treatment I
went to was his sixth session. When I asked him if he had felt ECT was working for him
he said that he has noticed an ability to think more clearly and that he is optimistic about
feeling happier in the near future.
Given this opportunity, it opened my eyes to understanding that ECT is not the
inhumane act that early movies and media portray it to be. The clients benefit from it, as
well as the nurses and health care professionals working with them. They are aiding
them in their recovery from their mental health illness and when medications seem to be
ineffective, ECT may be able to help. Research regarding ECT has been on going in
order to reverse the publics negative stigma and to help educate people about the
benefits regarding ECT.

Process of Accessing the Research
There is a lot of peer-reviewed literature out there regarding the use of ECT
treatment. While researching, I was interested in the stigma behind it along with the
nurses role when caring for a client who is under going ECT. I researched key words
such as, nurses attitudes toward ECT, negative stigma regarding ECT, Positive
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affects with ECT, etc. The research engines used were from the UNH databases such as,
MEDline, PubMED, and Cochrane. I limited my searches so that the entire linked full
text would be available along with the option to only view peer reviewed journals no
more than 10 years old. I discovered that there is a lot of research regarding this area and
I was able to find a lot of useful information about it.

Argument: The Negative Stigma Regarding ECT Is and No Longer Should Be a
Problem.

Having the opportunity to view a ECT first hand as a nursing student I was
interested in the reactions of other nursing students seeing one for the first time as well.
Martin wrote, TV and film portrayals of ECT as a method of torture and coercion,
most notably in the movie One Flew Over the Cuckoos Nest, had had a strong influence
on the group (nursing students) and they remained uncertain and anxious about observing
ECT procedures. The same daunting fear was accurate for my experience. Movies,
such as the one mentioned above, put a negative stigma on ECT, leaving me with fear of
the unknown. However, after accompanying the client to this treatment, the fear soon
subsided and I began to realize how helpful this treatment could be for clients who are
mentally ill.
It is important for health care professionals to have an updated education
regarding this kind of treatment and understand its positive effects it can have on clients.
Kavanagh and McLoughlin wrote, Today, contemporary ECT is often viewed with
stigma and fear, which may be inhibiting the potential of an effective treatment for those
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suffering severe mental ill health in two ways; first, treating teams may be reluctant to
prescribe ECT and second, when prescribed, patients may be unwilling to accept it. If it
is unknown or has been seen as an inhumane act in our culture, this will obviously put
fear into the clients in which it cant actually help drastically.
Research can be found that states that ECT may be even more effective than some
medications provided to individuals with mental illness. Weiner and Falcone state,
Whereas antidepressant medication typically requires 4 to 6 weeks to induce remission,
a majority of patients who response to ECT do so within 2 to weeks. Particularly with
extremely ill individuals, such a time advantage can sometimes be life saving. This
information is important for health care professionals to be aware of when coming up
with the best treatment plans for their clients.
Common misconceptions regarding ECT treatment according to Cyrzyk include,
The lack of information given when practitioners obtain informed consent before
treatment, the unknown mechanism of action, and the continuing and substantial adverse
cognitive side effects and memory loss experienced by many people who have undergone
ECT. Health care professionals have the ability to inform clients about how ECT works
and reverse the negative stigma that comes with it. It is the responsibility of the health
care professional to inform the client and family about ECT and its adverse affects, but
more importantly how it is seen as a positive mechanism of treating mental illnesses such
as depression and in some cases mania and schizoaffective disorder.
Implications for Nursing Practice
Nurses, along with other health care professionals, are responsible for educating
and promoting comfort to clients undergoing ECT. Nurses have an important role in
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helping to reverse the negative stigma for the best interest of the client. ECT has been
proven to be an effective treatment for clients who are mentally ill and it is essential that
nurses educate the clients and families regarding the current research. Kavanagh and
McLoughlin state, The nurse has the responsibility to address the psychological needs of
the patient undergoing a course of ECT. This involved ensuring the patient is fully
informed about their illness the ECT teaching serves to educate the patient, develop a
therapeutic nurse-patient relationship, reduce anxiety, and dispel myths or negative
preconceived ideas often present before treatment. Patient education concerning the
negative stigma related to ECT is a fundamental aspect of the nursing process when
caring for a client who is mentally ill.
Nursing education is also an essential aspect in caring for a client undergoing
ECT. The more knowledge a nurse has about ECT, the more knowledge can be provided
to the clients and families. Nursing education regarding ECT has improved since earlier
years and the more they know, the more clients can understand.
Another important nursing implication is experience. The more experience nurses
have with ECT, the more real life opinions and knowledge they can provide to their
clients. Gass states, increased knowledge correlated with length of experience. More
experience could provide first hand exposure to both the practical administration of ECT
but also to the outcomes and side-effects attributed to the treatment process. Nurses are
able to explain the process and the common adverse effects to clients if they have more
exposure and experience with the treatment themselves.
The nurses involvement during ECT is essential to the process. They are
responsible for the pre-treatment education, assessing the client during the procedure, and
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post-treatment care. Gomez states, Mental health nurses are involved in patient
assessment and care prior to, during, and post treatment. Nurses are involved in patient
and family education. Nurses attitudes and knowledge about this treatment impact
patients, families, and the community. The care of the client throughout this procedure is
extremely important in order to provide comfort and safety. Families are often very
skeptical about ECT when they are offered to one of their family members. Nurses are
able to expand their knowledge and advocate for the effectiveness of ECT.
Often times clients or their families are very anxious and uncertain regarding
ECT. Clients who undergo ECT may have tried pharmacological treatments for their
illness, which have proved ineffective, and their prescriber may mention ECT. This
spikes anxiety to the clients and may pose some doubts. Van and Gallagher state,
Nurses can have an impact on the quality of care of their patients in areas of altered
comfort, anxiety, knowledge deficits, and changes in self care. Patient comfort is one of
the most important nursing assessments and interventions involved in ECT. Whether the
client is voluntarily or involuntarily treated with ECT, their comfort is essential for the
treatment to be effective.

Conclusion
ECT has been misjudged by the media as being cruel, inhumane, and
unnecessary. When our society puts a message in our heads and portrays it negatively in
films and other sources of media, people tend to believe what they see. Research has
been done extensively regarding ECT with the mentally ill in order to take away the
negative stigma associated with it. It is the role of the health care professional and
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researchers to provide accurate information regarding this treatment to help positively
affect these clients who are suffering.
Evidence based research is what drives the practice of health care professionals.
Current evidence based research provides information regarding the positive effect of
ECT on clients with depression, mania, and other mental illnesses. In order to promote
this to the public and to the clients it is necessary to understand the current research that
is out there and not rely on the medias misconceptions about this treatment.
Overall, research has been done to supply knowledge to individuals regarding the
negative stigma that comes along with ECT and many other aspects of the mental health
setting. Wilkinson and Daoud explain, If we regard ECT as something to be wheeled out
of the eleventh hour and quickly hidden again, it is no wonder our patients treat it with
circumspection. ECT must be seen as part of an electric and pragmatic approach to the
treatment of severe depressive illness. It can continues to relieve distress and save
lives and may come to be seen as a treatment of choice not simply by psychiatrists but by
the public as well. The importance behind patient education cannot be stressed enough.
It is the responsibility of the health care provider to educate and provide the knowledge
necessary to the client regarding the positive qualities of ECT with their illness.
Finally, the research is robust regarding this topic. All in all it is clear that many
people still have a negative outlook on it, but we as health care providers can change that
and make this a treatment that can not only cure clients of their symptoms, but save their
lives down the line as well. Popeo simply stated, It is effective and safe. This is the
exact impression and information we need to give to the public to disregard the negative
stigma that has been partnered with this effective and humane procedure.
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Bibliography
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Gass, J. P. (1998). The knowledge and attitudes of mental health nurses to electro-convulsive
therapy. Journal of Advanced Nursing, 27(1), 83-90. doi:10.1046/j.1365-
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