1. The controversial Nursing perception of Electro convulsive Therapy: A true
Experience from Egypt
Author:MahmoudAgiza
StudentNurse- Facultyof Nursing/The BritishUniversityinEgpt
Electroconvulsive therapy (ECT) still one of the most debatable treatments for
psychological diseases and still a subject of emotional arguments among different groups in
the world. ECT is used for more than fifty years and is considered the oldest psychiatric
physical treatment. The Egyptian media introduced ECT in a very negative way though
different movies and many Egyptians have a negative impact of treatment using ECT and
perceived as a form of violence against patients. As a student nurse; I had several
experiences with ECT administration and found that Applying ethical values to a clinical
practice needs consideration of variety of aspects and can be challenging. I witnessed one of
the painful situations when ECT was administered against patient’s well and I couldn’t help
or interfere. This happened in one of the teaching hospitals where my patient was diagnosed
with major depression and being treated with electroconvulsive therapy without obtaining
his consent. The patient diagnosed with major depression and attempted to suicide before
being hospitalized. The patient was worried about the adverse effects after he experienced
the situation once before and hated the experience of ECT. The first session was
administered against patient’s well and the psychiatrist responsible for his treatment has
observed patient’s fear and worries, but he prescribed the ECT again although the patient
refused the treatment. Unfortunately, the medical team enforced the patient to undergo
ECT aggressively using restrains. This situation occurred many times for other patients later.
This experience raised many concerns in my mind related to the nursing role in the process
of administration of ECT and regarding the ethical values of justice and non-maleficence,
along with other issues (Flanigan2010). I wish I could interfere to protect the patient and
decrease his suffer and pain but I was under training and wasn’t aware of hospital policy and
possible ways of raising complaints. After this experience, I decided to develop knowledge
about ECT in general and the nursing role with patients who will receive ECT.

2. I discovered that I had an advocacy role towards my patients and that I should be
aware of the Egyptian mental Health act and other legislations to be able to help the patient
and defend his rights. As a nurse, I realised that mental health nursing is not only about skills
and years of experiences but it’s also about knowledge of country legislations, human rights
and organizational strategies. Therefore, I started to develop knowledge about the nature of
ECT and effect on the brain. The first electroconvulsive therapy treatment used to treat
psychiatric disorders including depression and schizophrenia was performed in Rome by
Italian psychiatrist “UgoCerletti and LucioBibi” in April 1938. Electroconvulsive therapy is
defined as a type of therapy in which through electrodes are positioned on the temples,
electric current is applied to the brain to induce a generalized seizure and acquire the
preferred result (Townsend 2011). The dose of electricity used in ECT ranges from 70 to 125
volts of electrical current for 0.7 to 1.5 seconds. The patient then experiences two phases of
seizures. The tonic phase remains about 10 to 15 seconds and then the colonic phase is
observed and lasts for 30 to 60 seconds (Townsend 2011).I lacked this knowledge before ,but,
when I read these documents, I understood how and when ECT started and what is the dose
and effect on patients and the more I know about the procedure and its details the more I gain
confidence that I can help and support my patients.
The nurse has a significant role before, during and after the ECT, yet, nursing role
can’t be achieved without the cooperation with the whole team of psychiatrist, anesthesia
doctor, head nurse and social worker. Nursing is about caring for others but it’s also about
giving voice to patients, support them and stand up for them whenever required.
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