Knowledge about and attitudes towards ECT: methodological issues.

BACKGROUND: There is a long history of nursing practice in the area of electroconvulsive therapy (ECT). Opinions on the involvement of nurses in this treatment reflect the wider debate on its use in the professional and popular media. There is extensive literature on the issues raised by this particular treatment but little research into what nurses actually do when working with patients receiving ECT. OBJECTIVES: The research question was: How do mental health nurses work with patients having electroconvulsive therapy? DESIGN: This was a Grounded Theory adopting a 'hybrid' approach to the methodology influenced by the differing perspectives of both co-originators, Glaser and Strauss. SETTINGS: The research took place in wards and ECT departments in two hospitals in Scotland. PARTICIPANTS: Twenty-four mental health nurses, including 4 students working in National Health Service hospitals in Scotland were accessed through purposive, then theoretical sampling. This included non-participant observation of nurses in their work with patients throughout the treatment period and unstructured interviews. METHODS: Analysis was based upon the constant comparative approach with open coding of data that was examined and compared for similarities and differences. This determined further data collection and theoretical development with regard to their properties and relationships to other codes until the point of saturation. RESULTS: Nurses' actions in ECT characteristically involve two role groups: relational roles and treatment roles and two dilemmas: uncertain role and uncertain relationships. The core category 'being there' comprising 'engaged', 'present' and 'detached' accounts for nurses' actions in the ECT drama, approaches to difficulties encountered, and, paradoxically, how such actions contributes to this. Slipping is postulated as the basic social psychological process enabling nurses to manage their contact with the patient.

Electroconvulsive Therapy↗

PubMed2006

Value of BIS-monitoring for electroconvulsive therapy.

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Electroconvulsive Therapy↗

PubMed2006

Recent advances in optimizing electroconvulsive therapy.

This review aims to summarize and critically evaluate the evidence for recent advances and alternative approaches in electroconvulsive therapy (ECT) technique. Novel developments in ECT research are also mentioned. An EMBASE literature search was undertaken of clinical trials, case reports and research updates on novel and alternative approaches in ECT practice and research, including alternative electrode placements, variations in stimulus configuration, and novel developments (magnetic seizure therapy, focal electrical stimulation). The evidence for these approaches is reviewed, and implications for the optimizing of ECT in clinical practice are discussed. Evidence from studies suggests that unilateral ECT be given at substantially suprathreshold doses (at least 6 times seizure threshold) for maximizing efficacy, while bilateral ECT is likely to be effective at doses of 1.5-2.5 times seizure threshold. There is some evidence to support the use of bifrontal ECT, although further research is required to establish its efficacy and side-effects relative to standard unilateral and bilateral electrode placements. Other alternative electrode placements have been minimally studied. More advantageous efficacy side-effect outcomes may be achieved by reducing the pulse width and/or frequency of the ECT stimulus. Lastly, novel developments using alternative means of seizure induction (magnetic fields, focal electrical stimulation) may hold promise for the future. Clinical practice should be guided by a careful appraisal of the available evidence for alternative approaches in ECT technique.

Electroconvulsive Therapy↗