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Observing electroconvulsive therapy

Thomas, Rachel C. SN

doi: 10.1097/01.NURSE.0000429811.64600.64
Department: STUDENT VOICES
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Observing electroconvulsive therapy

Rachel C. Thomas is a nursing student at Drexel University in Philadelphia, Pa.

The author has disclosed that she has no financial relationships related to thi

MEDICAL TREATMENTS are constantly changing. Many that were once viewed as effective and therapeutic are eventually discarded as outdated and even barbaric. But research constantly shines new light on medicine, in some cases rekindling interest in older therapies from the past. One example is electroconvulsive therapy (ECT).

In its prime, ECT was performed to treat many psychiatric maladies, particularly schizophrenia, and was associated with serious adverse effects, such as memory loss and bone fractures.1,2 Today, administered with general anesthetic and improved protocols, ECT safely and effectively treats specific psychiatric disorders such as severe depression and catatonia.1 It's generally used when more conservative therapies, such as antidepressant medications and psychotherapy, are ineffective.3,4

In ECT, an electrical stimulus is applied to an anesthetized patient's brain to induce seizures in a controlled setting.5 This article describes my experience participating in ECT procedures at a behavioral health center located in Philadelphia, Pa.

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My introduction to ECT

When I learned I'd have the opportunity to witness ECT firsthand, I wasn't sure what to expect. My preconceived notions included horror stories from movies and books depicting poor treatment and little respect for patients with psychiatric disorders, as well as the disturbing physical effects of the procedure itself. I was concerned with how the treatment would be performed, how the patients would react, and whether the staff would perceive me, a nursing student, as an inconvenience. So I was very pleased to find out how friendly and knowledgeable the staff was, how well they treated patients and responded to their concerns, and how smoothly the sessions went due to the professionalism and collaboration of the various healthcare professionals. I also appreciated how the staff members included me and answered all of my questions.

During each treatment, a physician, a resident, a nurse anesthetist, a direct care nurse, and I, all stood near a bed where patients would be placed for the procedure. The bed is a standard hospital bed with side guard rails that aren't raised. Next to the bed was equipment that monitored SpO2, heart rate and rhythm, and BP.

This team of professionals flawlessly went through each ECT procedure with such accuracy and precision; the high levels of communication and teamwork really showcased the quality of the facility and the expertise of the healthcare team. During my time at the behavioral health center, I witnessed seven ECT procedures, and each one lasted roughly 5 minutes.

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Old procedure, safer practice

After the patient is prepped, the treatment begins with the nurse anesthetist administering a general anesthetic. Within minutes, the patient starts to feel the effects and can no longer move. After the patient is sedated, the physician induces a seizure via an electrical stimulus administered through electrodes applied to the patient's head. The strength of the ECT voltage (V) is calculated based on the patient's age, gender, medical conditions, and electrode placement. Once the shock is given, the induced seizure is expected to last at least 30 seconds. The 30-second duration is standard because seizures lasting less time may not be strong enough to alter brain chemistry.6

During the procedures, I was asked to help monitor patients for length and effectiveness of the induced seizures. Along with the nurse, my job was to hold the patient's wrist and ankle and count how long subtle muscle spasms lasted.

Once the therapy is completed, the nurse anesthetist begins to rouse the patient. Patients typically experience acute confusion and must be reoriented to where they are and why they're there.1 The effects of acute confusion typically wear off in 10 to 30 minutes following ECT; however, some patients experience anterograde amnesia and/or retrograde amnesia with longer-lasting memory loss.1

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Postprocedure care

During the recovery period, the nurse's job is to continue to support the patient through his or her arousal and reorientation.

I thought this was an excellent example of true nursing care. Safety is a major concern during this time because patients can be confused and aggressive when recovering from anesthesia. Staying with patients while they regain consciousness and maintaining the safety of patients, yourself, and others in the area is an important responsibility.

I was asked to stay with one patient who was just recovering from anesthesia. I stood by her bedside and softly reminded her where she was and that she'd just completed her treatment. At one point, she tried to stand while still sedated and attached to the heart monitor. I had to remind her that, for her own safety, she needed to continue to rest before she attempted to ambulate with assistance.

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A nurse's role in ECT

Going through an ECT session can be a scary experience. Patients have a lot of questions associated with the procedure, and the treatment itself can stir many emotions.

Patients and their families look to the nurse for care and support. Before the procedure, the nurse makes sure the patient and family understand what's about to happen, addresses any concerns they may have, and answers their questions about the procedure. Patients are comforted by having someone there who advocates for them and whose main focus is their care and safety.

Observing ECT was a great experience that piqued my interest in psychology, the workings of the human brain, and psychiatric treatments. It was wonderful to observe how ECT is performed and to participate in patient care. As a future nurse, I was privileged to see firsthand how this medical procedure is performed and what the nurse's role is in the process.

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REFERENCES

1. Kellner C. Overview of electroconvulsive therapy (ECT) for adults. UpToDate. 2013. http://www.uptodate.com.
2. Electroconvulsive therapy (ECT). Mayo Clinic. 2013. http://www.mayoclinic.com/health/electroconvulsive-therapy/MY00129.
3. Kellner C. Unipolar major depression in adults: indications for and efficacy of electroconvulsive therapy (ECT). UpToDate. 2013. http://www.uptodate.com.
4. National Institute of Mental Health. Brain stimulation therapies. 2009. http://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml.
5. Cita B. A nurse's guide to electroconvulsive therapy. Nursing. 2012;42(10):41–44.
6. Murphy K. Is ECT an option for your patient with severe depression. Nursing Made Incredibly Easy! 2013;11(3):37.s article.
© 2013 Lippincott Williams & Wilkins, Inc.