Nursing Assessment, Interventions and Evaluation of Mood and Mental State
Nursing Assessment, Interventions and Evaluation of Mood and Mental State
Nursing Assessment, Interventions and Evaluation of Mood and Mental State
Pre-treatment nursing care should begin before ECT is prescribed and continue until people receiving
care enter the ECT suite. Nurses who provide pre-treatment care must be competent in:
• identifying and applying legislation that relates to ECT and explaining the legislation to individuals and
their carer or families
• effectively communicating and providing education and support that is appropriate to the needs of
individuals and their carer or families with regard to their care and treatment. The following additional
points should be considered
– it is important for people to have accurate, concise information
– nurses should assess a person’s understanding and recognise that people may require this
knowledge to be reiterated and explained in different ways.
A significant priority for nurses at this time is to provide educational and psychological support to people
undergoing ECT and their carers and to prepare people for treatment. To inform their care, nurses must
be competent in assessing an individual’s current mental state, legal status, medical status and trauma
history. In addition, nurses must also recognise and support people’s needs in relation to gender and
culturally sensitive practice and the impact of ECT on people and their families or support people.
Moreover, nurses should be aware of the indications for ECT given they are accountable for providing
education and support to people undergoing ECT and for developing care plans, and are in a position to
note changes in people’s physical and mental state in the time between prescription of ECT and
treatment. The RANZCP (2007) has stated that the indications for ECT include:
• major depression
– especially with catatonic, melancholic or psychotic features, with or without suicidal risk or failure
to drink or eat adequately
– when the response to antidepressant medication has been inadequate
• mania
• schizophrenia with acute features.
Table 2: Nursing considerations in the preparation of individuals and suites for ECT
ACTION RATIONALE
Ensure that the person is adequately hydrated the day To reduce the possibility that dehydration occurs when
before treatment. the person fasts
Arrange for safekeeping of the person’s valuable To ensure the person’s valuables are looked after and
items. there is a documented record of this
Explain the procedure, including side effects, to the To reassure the person about the treatment using a
person using educational pamphlets and videos as number of methods to support their understanding of
appropriate and answer questions that they may ECT and the care associated with its administration
have.
If others wish to be present to observe ECT, request To ensure the person is comfortable with who will be
permission from the person. present in the ECT suite and why they will be there. ECT
is directly relevant to medical and nursing students. If
other disciplines are to be present this should only occur
with consent and if it is purposeful (for example, if the
person is a case manager and not from a medical or
nursing background).
Have the person fast (food and fluids) for six to eight To prevent excessive bronchial secretions and possible
hours and abstain from smoking for two hours prior to aspiration during general anaesthesia
the procedure or in accordance with local policy or as
otherwise advised by the anaesthetist.
Ensure pre-testing occurs prior to ECT by To enable comparisons to be made between pre- and
administering a simple cognitive test. post-ECT results so that any changes to cognition as a
result of ECT can be identified and considered
Ensure medications are given as prescribed. To ensure medications (for example, cardiac
Determine what medications must be taken at their medications) are administered on time if there is a need
regular time and what medications may be delayed to do so and to delay other medication until after ECT
until after ECT. Administer accordingly. following consultation with the anaesthetist
Ensure the person is not wearing make-up, nail To ensure they do not interfere with or impact on the
varnish or body piercings. Assist in removing them if treatment site or prevent the observation of hands and
they have not done so. feet following the administration of anaesthetic
Ensure the person’s hair is clean and dry and hairpins, To ensure appropriate electrode contact is not prohibited
hairnets and other hair ornaments are removed.
Encourage the person to empty their bladder before To reduce any discomfort, bladder distension and
treatment. complications that may arise due to a full bladder
Have the person remove any prostheses, loose-fitting To assist the person in their mobility and
dentures, glasses, hearing aids and contact lenses communication, it is beneficial for people to use their
immediately prior to the administration of the sight and hearing aids for as long as possible before
anaesthetic. treatment. Their removal is required so they won’t
interfere with treatment
Check the person’s identity in multiple ways and To ensure the right treatment is administered to the
ensure that an identity band is being worn by the right person
right person.
When the person is an outpatient, ensure that they To ensure that the person will be safe and cared for
have agreed to not drive and will have a responsible after treatment
adult care for them during the first 24 hours after
treatment. Also, book further ECT appointments.
Have a nurse who the individual knows and who is To minimise and address any anxiety that the person
aware of their legal and consent status escort the may be experiencing
person to the treatment waiting room.
Perform the pre-treatment checklist for general To ensure the person is ready for general anaesthesia
anaesthesia and ECT. and ECT
Have outpatients who may have travelled long To allow maximum recovery time
distances treated at the beginning of the day.
The ECT coordinator has a role to monitor and mentor To ensure quality of care and contribute to staff
other nurses. development
Ensure adequate handovers occur. To support the continuity of care
Provide support as required to the psychiatrist and To facilitate individual care to the person receiving ECT
anaesthetist.
Ensure documentation is completed. To support the continuity of care
Prepare equipment and consumables needed for To ready the ECT suite for the administration of
treatment. This includes ensuring local policies and treatment
procedures are developed in relation to the set-up and
cleaning of the ECT suite and equipment with regards
to the disinfection and autoclaving of equipment.
Record physical observations. To facilitate monitoring of the individual’s progress
Providing care during treatment sessions
Nurses have an important role in the provision of care during treatment sessions. Nurses
are responsible for:
• facilitating an environment that ensures the safe treatment of ECT
• collaborating in decision making about the person’s care with members of the multidisciplinary team.
The functions nurses perform may depend on what other staff are present in the treatment room and
may differ among ECT suites. Tasks that need to be completed during treatment sessions are detailed in
Table 3 and the nurse is responsible for the appropriate procedure being correctly followed.