Background: Electroconvulsive therapy (ECT) is a non-pharmacological psychiatric treatment. ECT has evolved into a complex therapy with a low risk of adverse effects that is conducted under anaesthesia with muscle relaxants. The goal of this study was to identify nursing students’ knowledge and attitudes regarding the usage of ECT.
Methodology: The research was conducted in a cross-sectional design in which the knowledge and attitudes of nursing students about the usage of ECT were assessed using ECT knowledge and attitude questionnaires. The Statistical Package for the Social Sciences was used to do statistical analyses.
Results: A total of 107 nursing students participated in this study. None of the participants had complete knowledge regarding the usage of ECT. Although some of the students had knowledge of the ECT procedure and technique for obtaining consent, most of the participants had poor knowledge about ECT and its side effects. In terms of attitude, Negative attitudes about ECT were extremely common among many of the students.
Conclusion: Although nursing students are knowledgeable about the basics of the ECT process and consent, they have deficient knowledge of its effectiveness, mode of action, indications, and adverse effects. Nursing students have a strong negative attitude toward ECT. It is essential to encourage trainers to identify these gaps and negative attitudes, as well as to eliminate any myths through scientific evidence. To fill such deficiencies, there is a need to establish a curriculum that is more pro-ECT.

Attitude, Usage, Knowledge, Electroconvulsive therapy, Students, Nurses.

ECT is a non-pharmacological psychiatric treatment. ECT has evolved into a complex therapy with a low risk of adverse effects that is conducted under anaesthesia with muscle relaxants.[1] When an electrical current is delivered to a patient’s brain with the purpose of improving their mental condition, ECT causes a generalized cerebral seizure.[2] The Irish college of psychiatrists adopted a set of recommendations on ECT, if people with severe depression should undergo the procedure.[3]

Although drugs and various forms of therapy are routinely used to treat people with mental illness, these processes may not always work for everyone, and ECT may be advised.[4] Patient’s rights movements and anti-psychotic sentiments in the 1940s led to sparked controversy about whether ECT was employed as a form of punishment or therapy. This condemnation received a lot of attention in the media and the press. In many industrialized countries, ECT was eventually phased out in the 1950s, Then it was later replaced with a modified form that enhanced the safety of ECT treatment while lowering the negative effects.[5]

As the ECT continued, the electrode placement and aesthetics were all refined as the treatment progressed.[6] ECT is well-known for its safety and efficacy in clinical care; opinions on its acceptability and administration are widely divided. There is a lot of research on how patients feel about undergoing ECT, but there isn’t much on how they feel about it.[7] The therapy’s rudimentary historical beginnings, the continuous and severe adverse cognitive side effects, and the disparities in attitude among physicians, nurses, and consumers about ECT are all factors that contribute to such conflicts.[8] Despite this, ECT has a negative reputation among medical professionals, particularly nurses, who hold an unfavourable opinion of ECT.[1] Lack of understanding and unfavourable attitudes tend to promote the negative implications associated with ECT.[9]

Nursing students’ knowledge and attitudes regarding the usage of ECT has an impact on their patients’ Attitude and knowledge toward ECT even though they spend the most time with patients than every caregiver as well as provide critical and useful nursing interventions to patients receiving ECT prior to, throughout, and even after the treatment session.[10] Nursing students will become future nurses, and because nurses work directly with individuals both before and after ECT, their attitudes and knowledge related ECT.[11] This will have a significant effect on their personal performance in nursing practice. Furthermore, empowering nursing students with concise lectures, learning with videotapes, familiarization with ECT technology, and experience with the ECT treatment can help change their negative attitudes.[1]

Nursing students who have never seen ECT management in patients or have been on a psychiatry rotation before would be the best group to assess and determine the basic knowledge and attitudes regarding ECT, as well as to design measures to overcome their negative attitudes and knowledge deficits.[12]

Individuals who are getting ECT are frequently misinformed about the procedure. According to researchers’ findings, no such study was found related to the knowledge and attitudes of nursing students towards the usage of ECT. Knowledgeable nurses may increase the quality of patient care. Hence, improving the knowledge of nursing students can improve clinical outcomes for psychiatric patients. Recovery principles will enable patients to cope with a sense of independence and more confidence when they are treated with more respect and compassion. This research will encourage new approaches to improving knowledge and attitudes regarding ECT. As a result, nurses will be more competitive. The institute may create quality interventions, like the ECT training and education, to help nursing students overcome knowledge deficits. This study will enhance nursing students’ knowledge regarding ECT and, more significantly, enhance their attitude regarding it. As a result, having a more positive attitude will improve patient care with severe mental illnesses and serious mental illnesses. We wanted to see how much nursing students understood about ECT and how students thought about it. The objective of the study was to assess knowledge and attitudes regarding the usage of ECT among nursing students.

The research was conducted in a cross-sectional design. The study setting was Lahore School of Nursing, The University of Lahore, and Bahria Town School of Nursing, Lahore. The research was carried out from September 2021 to December 2021. The Participants of the study were third-year, fourth-year BSN students and second-year post-registered nurse students. Sloven’s formula was used to get the sample size:
n= N/(1+N(e)2)
Where the population is (N), the margin of error is (e), and the sample size is (n)
N=146, e=0.05, n=107

The population selected from Lahore School of Nursing, including 3rd year, 4th year, and 2nd year Post RN, was 123, and the population selected from Bahria Town School of Nursing, including 3rd year BSN students, was 23. Sum of the population size was 146. A total of 107 people were included in the study. A convenient sampling technique was used for this study. Included population was BSN Students of the 3rd year and 4th year, and 2nd year Post RN students. Students between the ages of 20 and 25 years, as well as those above the age of 25 years. Students who willingly gave their informed consent. Excluded population was Physician, Nursing staff, and paramedics. Students who refused to take part in the research. Research instrument was adopted from previous research.[8] The questionnaire consists of three sections. Section I has demographic information, section II comprises 08 knowledge questions along with responses of ‘A, B, C, D,’ and section III contains 16 attitude questions with responses of ‘Strongly agree, Agree, don’t know, Disagree, strongly disagree.[8] The total knowledge score was divided into three categories: good (71-100%), moderate (51-70%), and Poor (0-50%). The total attitude score was 100 percent. Positive attitude (≥80%) and negative attitude (≤79%) were used to classify attitudes of the participants.[3] While conducting the study, the ethical committee of the University of Lahore followed the norms and regulations, and the rights of the research participants were protected. All participants were asked to provide written informed consent. All information and data gathered were kept private. Throughout the research, participants remained anonymous. The participants were informed that there are no problems or drawbacks to the research method. The information was kept under lock and key. It was password-protected on the laptop. Nursing students who were present at the time of data collection were given questionnaires. It took around 10-15 minutes for it to fill. The data was analysed using IBM statistical package for the social sciences (SPSS) Statistics version 22. Frequencies and percentages were used to analyse the data. Tables were used to present the variables.

The data was analysed by questionnaire, and the results are interpreted with the frequency and percentages.

 Table 1: Demographic data

Table 2: Knowledge regarding the usage of ECT

Table 2 shows the responses of students ‘ knowledge regarding ECT, in which 89(83.2%) respond correctly about “What is ECT?”. Total response 24(22.4) was 1-3 times about “How often is ECT given per week?”. In response to “How many ECT do most patients require in one course?” 12(11.2) respond, usually 1-10. “Where is the current applied? 79(73.8) respond to the head”. Who can administer ECT? 49(45.8) respond, Psychiatrists/doctors. How long has the current been applied? 61(57.0) responds in 1-6 Seconds. How is ECT given? 71(66.4) respond by a special machine. ECT is often used to? 42(39.3) respond that ECT is used to treat mental patients.

Table 3: Attitude regarding the usage of ECT

Table 3 shows the students’ attitude regarding ECT. Is ECT dangerous and should not be used?  strongly disagree 3(2.8%), neutral 21(19.6%), agree 30(28%), strongly agree 53(49.5%). Is ECT and inhumane treatment? strongly disagree 9(8.4%), disagree 18(16.8%), neutral 62(57.9%), agree 9(8.4%), strongly agree 9(8.4%). “I will advise a close relative to receive ECT if recommended.” Strongly disagree 3(2.8%), disagree 15(14%), neutral 12(11.2%), agree 52(48.6%), strongly agree 25(23.4%). Is treatment with ECT cruel? strongly disagree 12(11.2%), disagree 12(11.2%), neutral 12(11.2%), agree 18(16.8%), strongly agree 53(49.5%). Should treatment with ECT be outlawed? strongly disagree 3(2.8%), disagree 21(19.6%), neutral 24(22.4%), agree 24(22.4%), strongly agree 35(32.7%). Is ECT often given to people who do not need it? strongly disagree 12(11.2%), disagree 15(14%), neutral 47(43.9%), agree 21(19.6%), strongly agree 12(11.2%).

Nurses are usually available to patients and their families around the clock in the Pakistani setting, among the members of the mental health professionals. They can serve as an excellent source of information for patients and their families. Therefore, their knowledge and attitude have a major impact on the knowledge and attitude of patients. Hence, evaluating their knowledge and attitude can influence the finding of areas for intervention, significantly increasing the acceptability of treatments like ECT and patients’ overall outcomes. The early years are the best time to change false attitudes and poor understanding. Therefore, the current research examined nursing students’ knowledge and attitudes about ECT.

In our study, we determined that most of the participants had poor knowledge about the ECT effectiveness and indications. Participants had good knowledge on only two points, which are around 70% or above, i.e., “What is ECT?” and “Where is it currently applied?” Participants had moderate knowledge of another option, around 50% or more, such as “How long has the current been applied?” There was a lack of knowledge regarding the effectiveness and indications of ECT. A recent survey on nursing students reported that the most common areas of knowledge deficiencies regarding ECT were effectiveness, side effects, and indications.[1] According to the findings of this study, many nursing students were inadequate in their knowledge of many perspectives of ECT. The deficits in knowledge of nursing students are likely to promote ignorance among patients.

In terms of attitude, Negative attitudes about ECT were extremely common among many of the students. Negative attitudes regarding ECT were frequent. It’s important to recognize that these results have far-reaching implications. This is also in accordance with the findings of the previous study on nursing students, which revealed that they have a strong negative attitude regarding ECT.[8]

According to these findings, training and awareness programmes for enhancing the knowledge about ECT and addressing negative attitudes regarding ECT among nursing students are required. The difficulties of a professional attitude are usually suppressed in the regular course curriculum. Hence, there is a need to raise knowledge among trainers as a result, there is a need to raise awareness among trainers to assess the attitudes of various professionals, such as nurses, toward various therapeutic strategies like ECT, and to address properly the issue by openly discussing it and eliminating misconceptions based on scientific evidence.

This project’s goal was to be descriptive and insight-oriented; the research does not seek to give an overall investigation of the ECT. But rather to enlarge the range of possible groups and subjects, the findings were not directly applicable to the entire population. Instead of focusing on the receivers, find and focus on potential recipients. This study lacks a random sample, uses a tiny sample group, and gathers data from a site that is more likely to be seen by someone who has had a negative experience with ECT.

The present study replicates this by increasing the sample size and using different settings. Investigating other concerns, including cultural difficulties, is being examined as a potential contributor to negative views regarding ECT. Establishing a culturally relevant, standardized method for assessing attitudes regarding ECT. The inclusion of qualitative research methodology may expand the understanding of the subject being studied. The use of qualitative research methods may help enhance the knowledge of the previously studied subject.

The current study finds that nursing students have false knowledge about the usage of ECT. Furthermore, nursing students have a strong negative attitude toward ECT. It is essential to encourage trainers to identify these gaps and negative attitudes, as well as to eliminate any myths through scientific evidence. To fill such deficiencies, there is a need to establish a curriculum that is more pro-ECT. The indications, mechanism of action, and other procedural elements of ECT should be taught to nursing students in a clear and unbiased manner. Such unbiased information would enable patients to make more sensible and balanced decisions about whether to consider ECT as a treatment modality, and it will lower the stigma, fear, and other negative perceptions associated with ECT.

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Corresponding Author:
Amjad Ali
Department of Nursing
Lahore School of Nursing, The University of Lahore, Pakistan
Email: samramjad119@gmail.com

Co-Authors:
Liaqat Ali, Rukhmah Afzal, Shahzaib Shabbir, Muhammad Afzal
Department of Nursing
Lahore School of Nursing, The University of Lahore, Pakistan

All authors contributed to the conceptualization, investigation, and data curation by acquiring and critically reviewing the selected articles. They were collectively involved in the writing – original draft preparation, and writing – review & editing to refine the manuscript. Additionally, all authors participated in the supervision of the work, ensuring accuracy and completeness. The final manuscript was approved by all named authors for submission to the journal.

The study was approved by the ethical committee of the University of Lahore, and the norms and regulations were followed, and the rights of the research participants were protected. All participants were asked to provide written informed consent. All information and data gathered were kept private. Throughout the research, participants remained anonymous.

Not reported

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https://doi.org/10.63096/medtigo30622434

Amjad A, Liaqat A, Rukhmah A, Shahzaib S, Muhammad A. Knowledge and attitudes toward electroconvulsive therapy among nursing students. medtigo J Med. 2024;2(4):e30622434. doi:10.63096/medtigo30622434 Crossref