Something Shocking.....

As health care practitioners we are faced with many challenges and diversities. In previous posts I have spoken about Ethics and it's impact on health care. As as RN's we are often put in positions in assisting or caring for patients who are undergoing treatments or procedures that ethically and morally push some of our personal boundaries.

Case in point. I remember when I was a nursing student and my instructor told me how tired she was of treating people who came in to the Emergency department for attempted suicide. I will never forget what she said to me one day. She said that some days she gets so frustrated that if they really wanted to kill themselves she would show them the correct way to do it. This really took me aback, but it opened up dialogue with my classmates to discuss situations that we would all be faced with in our nursing careers that will push our personal boundaries. In our discussion some students expressed that they might have problems nursing patients who are drug addicts or alcoholics, others expressed concern about dealing with patients who had or were seeking information on termination of an unwanted pregnancy. I remember asking the instructor if we had a right to refuse to work with a particular patient if it really went against our morals....she basically told me no. She said we had to treat all patients with the same care we would treat any patient. If we really had difficulties we could ask a colleague if they wouldn't mind trading assignments but basically it was our duty and responsibility to treat all patients with the same respect and dignity and professionalism. That has always stuck with me.

I to get frustrated at times with some patients who I see using the health care system as a revolving door. Not taking responsibility for their health issues. This of course happens for a variety of reasons. Often it is basically that they don't have the tools to make healthy life choices. This is often due to their socio-economic situation or their mental health.

This brings me to my current challenge. One of my duty as a recovery nurse it to care for patients who have had Electroconvulsive Therapy(ECT). Electroconvulsive therapy (ECT) is a procedure used to treat severe depression. It may be used in people with symptoms such as delusions, hallucinations, or suicidal thoughts or when other treatments such as psychotherapy and antidepressant medications have not worked. It is also used for other psychiatric and neurological conditions, such as schizophrenia and Parkinson’s disease.

Before ECT, you are given anesthesia to put you in a sleep like state and medications to relax your muscles. Then an electrical current is briefly sent to the brain through electrodes placed on the temples or elsewhere on the head, depending on the condition and type of ECT. The electrical stimulation, which lasts up to 8 seconds, produces a short seizure. Because of anesthesia, the seizure activity related to ECT does not cause the body to convulse.
It is not known exactly how this brain stimulation helps treat depression, so why do it I ask. They believe that ECT probably works by altering brain chemicals (similarly to medications), including neurotransmitters like serotonin, natural pain relievers called endorphins, and catecholamines such as adrenalin.

ECT treatments are usually done 2 to 3 times a week for 2 to 3 weeks. Maintenance treatments may be done one time each week, tapering down to one time each month. They may continue for several months to a year, to reduce the risk of relapse. ECT is usually given in combination with medication, psychotherapy, family therapy, and behavioural therapy.

I can remember as a nursing students when I was doing my psych rotation at a very old psychiatric hospital where they did the ECT's down in the basement of the building....I found it distressing....the patients were like cattle lined up outside the door...taken into a dark dingy room...treatment performed and then they were moved into this open room where they were drooling and noticeably out of it....they would be observed for a short period of time and then sent back to their wards. I didn't think this was a very good experience for my first time seeing ECT's.

Now here I am now caring for patients who are still having these treatments.....I do question the validity for some of them....I mean we have this one patient that we have to use restraints on because when they come out of the sedation they are extremely violent. I understand the rationale for the treatment but it doesn't mean I have to like it.

Nursing, is a wonderful profession and provides us as individuals so many opportunities to experience and explore healthcare on so many different levels.