A nurse is caring for a client who is undergoing electroconvulsive therapy. which of the following

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Emotional and Educational Support to the Client & Family
Pre-treatment Protocol for ECT
Nursing Care During the Procedure
Post treatment nursing care

ECT is a physical therapy in which with the help of electrodes, electrical current is passed to the brain to produce generalized seizures.
Modified electroconvulsive therapy (ECT) is a controlled medical procedure in which a seizure is induced in an anaesthetized patient to produce a therapeutic effect. (Kavanagh & McLoughlin, 2009)
Electroconvulsive therapy (ECT) is a highly technical procedure requiring a team that consists of an anesthetist, a psychiatrist, psychiatric nurses, and recovery nurses.
Psychiatric nurses have an important role in caring patients who receive ECT.

ECT is the most acutely effective treatment available for affective disorders and is more effective than antidepressant drugs. (Kavanagh & McLoughlin, 2009)

ECT may be considered as a primary treatment (or first-line treatment) for persons exhibiting syndromes such as: severe major depression, acute mania, mood disorders with psychotic features, and catatonia. ( Hogan MF & Paterson DA, 2008)

Severe depression
Acute mania
Mood disorders with psychotic featues
Intolerance to side effects of medication or other treatments
Deterioration in condition, or appearance of suicidality or pronounced lethargy.
Acute catatonia

Contraindications to ECT include brain tumors, space-occupying lesions, and other brain diseases that cause increased intracranial pressure.

Electroconvulsive therapy is treated like a minor surgical procedure that requires preoperative preparation and postoperative care. (Arkan B, Ustün B, 2008). There are four components of nursing care in ECT

Providing educational and emotional support
Pre-treatment planning and assessment
Preparing and monitoring the patient during the actual procedure
Post-treatment care and evaluation

Providing Educational and emotional support

Explain the procedure to the patient
Obtain an informed consent from the patient and the carer.
Respond to patient’s concerns and feelings.
Educate the patient concerning the procedure and explain to the patient the necessary tasks associated with ECT.
Initiate education interventions based on knowledge deficits.

Pre-treatment Nursing care

Preparation of treatment suite for the ECT procedure
An adjustable height stretcher trolley
Complete the pre-treatment check list.
The patient’s identity is checked and the patient wears an identity bracelet.
Ensure safekeeping of the patient’s valuables.
NPO for minimum 4 hours before treatment to prevent possible aspiration during anaesthesia.
The patient’s hair should be clean and dry to allow for electrode contact.
Hairpins, bracelets, body piercing should be removed to avoid burns.
The patient should be encouraged to pass urine before the treatment to avoid incontinence during the procedure.
Prostheses, dentures, glasses, hearing aids, contact lenses, should be removed.
Minimise anxiety through anxiety management techniques, ensuring short waiting time and offering reassurance and support.
Standard practices should be practiced regarding general anaesthesia care.

Nursing Care during ECT Procedure

Transfer the patient on a trolley from the waiting room to the ECT room on a well padded bed and placed in a comfortable dorsal position or supine position. A small pillow is placed under the lumber curve.
Apply ECG electrodes, BP cuff, and pulse oximetry sensor (not on same extremity as BP cuff).
Give a short acting anesthetic agent. Thiopental .25mg to .5 mg , IV and secoline (succynyl choline) 30-50 mg. The dose of drug may vary from patient to patient.
Prepare EEG electrodes, per treatment specifications.
Prepare scalp and stimulus ECT electrodes (unilateral vs. bilateral) and apply paste to electrodes.
Support the shoulder and arms of the patient. Restraint the thigh with the help of a sheet.
Hyperextension of the head with support to the chin.
Administer oxygen
Apply jelly to the electrodes
Make the observations of the convulsions.
The presence of initial tonic stage which lasts for 10-15 seconds followed by clonic stage which lasts for 25-30 sec then there is a phase of muscular relaxation with stertorus respiration ie flaccid stage.
Do suction immediately
Restore respiration by giving O2 if necessassry.

Post-ECT Care

Observe and record the vital parameters

Place the patient on side lying position, clean the secretions

Transfer the patient from recovery room . record vital signs every 15 min for 30 min and once in every 30 min till the patient recover to the normal stage.

Allow the patient to sleep for 30 min to one hour
Reassure the client and reorient to the ward

Allow the patient to have tea or any drinks

Treatment devices and supplies, including electrode paste and gel, gauze pads , saline, electro encephalogram electrodes and chart paper.
Monitoring equipments including ECG and EEG electrodes
BP cuffs, peripheral nerve stimulator and pulse oxymeter
Stethoscope
Reflex hammer
Intravenous and venipuncture supplies
Stretchers with firm mattress with side rails with the capacity of raising the head and foot end
Bite blocks
Suction device
Ventilation equipment, including tubing , masks, Ambu bag, oral airways , intubations equipments with an oxygen delivery system capable of providing positive- pressure oxygen
Emergency and other medications as recommended by the anesthesia staff
Miscellaneous medications not supplied by anesthesia staff for medical management during ECT such as midazolam, diazepam, thiopental sodium, glycopyrolate, succinyl choline etc.

Document using flow sheets or progress notes.
Record the patient's vital signs and responses during the treatment sequence, recovery, and post-recovery.
Document medications, stimulus parameter, seizure response and vital signs
Assess and document the patient's physical and mental status and any behavioral changes or lack of such changes

Psychiatric nursing care for the electroconvulsive therapy (ECT) patient has evolved from a traditional supportive and adjunctive practice to the current practice of independent and collaborative nursing actions. The nurse's multifaceted role in ECT is enacted by providing education and support, performing pretreatment assessments, monitoring the procedure, and observing and interpreting posttreatment patient responses. (Burns & Stuart GW, 1991)

Although in use for 70 years, ECT continues to attract controversy and there is considerable stigma associated with its use that often overshadows the empirical evidence for its effectiveness. One way to overcome this is for health professionals to be educated about contemporary ECT practice. Patients need to make informed decisions when consenting to ECT and this process can be influenced by preconceived ideas and scientific fact. (Kavanagh & McLoughlin, 2009).

Kavanagh A, McLoughlin DM. Electroconvulsive therapy and nursing care. Br J Nurs. 2009;18(22):1370-7.
Hogan MF, Paterson DA. Electroconvulsive Therapy Review Guidelines. office of the Mental Health, New York State.
Arkan B, Ustün B.Examination of the effect of education about electroconvulsive therapy on nursing practice and patient satisfaction. J ECT. 2008 ;24(4):254-9.
Stuart GW. Laraia MT. Principles and practice of psychiatric nursing. 1st edn. Noida. Mosby publishers.2001
Townsend MC. Psychiatric mental health nursing. 3rd edn. Philadelphia. FH Davis publishers
Kapoor B. Text book of psychiatric nursing, vol-II. 1st edn.Delhi.Kumar publishing house.2006.
Munday J, Dean C, Little J. Effectiveness of a training program for ECT nurses . Journal of psychosocial nursing and mental health services, 2003:41; 20-26.
C. H. Kellner, D. M. Popeo, and A. S. Aloysi. Electroconvulsive Therapy for Catatonia Am J Psychiatry, September 1, 2010; 167(9): 1127 - 1128.
Burns CM, Stuart GW. Nursing care in electroconvulsive therapy. Psychiatr Clin North Am. 1991;14(4):971-88.

This page was last updated on: 19/12/2020

Electroconvulsive therapy (ECT) is a procedure in which electric currents are passed through the brain, deliberately triggering a brief seizure. Electroconvulsive therapy seems to cause changes in brain chemistry that can immediately reverse symptoms of certain mental illnesses. It often works when other treatments are unsuccessful.

Nurses have an important role to deliver when a client is to undergo Electroconvulsive Therapy. Find out what are the responsibilities and activities of the nurse during electroconvulsive therapy.

Emotional and Educational Support to the Client & Family

Encourage the client to discuss feelings, including myths regarding ECT.
Teach the client and the family what to expect with ECT.

Pre-treatment Protocol for ECT

Ascertain if the client and the family have received a full explanation, including the option to withdraw the consent at any time.
Withhold food and fluids for 6 to 8 hours before treatment.
Remove dentures, glasses, contact lenses, hearing aids, hair pins and etc.
Have client void before the treatment.
Give preoperative medications as ordered:
- Give either glycopyrrolate (Robinul) or atropine to prevent potential for aspiration and to help minimize brady-arrhythmias in response to electrical stimulants.

Nursing Care During the Procedure

Place a blood pressure cuff on one of the client’s arms.
As the intravenous line is inserted and EEC and ECG electrodes are attached, give a brief explanation to the client.
Put on the pulse oximeter to the client’s finger.
Monitor blood pressure throughout the threatement.
Medications to be given:
Check if the bite block is placed in prevent biting of the tongue
Electrical stimulus given (seizure should last 30 to 60 seconds).