Addressing Electroconvulsive Therapy Knowledge Gaps and Stigmatized Views Among Nursing Students Through a Psychiatrist–APRN Didactic Partnership

Abstract

BACKGROUND: Knowledge gaps and stigmatized perceptions regarding electroconvulsive therapy (ECT) among patients and health providers contribute to the underutilization of an important therapeutic modality. The proactive education of future advanced practice registered nurses (APRNs) provides an opportunity to optimize the use of this evidence-based clinical practice. AIMS: As part of a general course in psychiatry during the first year of nursing school, we dedicated 1 hour to treatment-refractory depression, including ECT, and a second hour to a summary discussion of mood disorders. We evaluated the efficacy of this didactic offering, which was co-taught by a psychiatrist and a psychiatric APRN. METHOD: At baseline, consenting students ( n = 94) provided three words they associated with ECT and then completed three validated instruments: (a) Questionnaire on Attitudes and Knowledge of ECT, (b) Opening Minds Stigma Scale for Health Care Providers, and (c) Self-Stigma of Seeking Help. Among the 67 students who repeated the assessment at endpoint, 39 attended the ECT didactic (Intervention group, 58%) and 28 did not (Control, 42%). RESULTS: After completion of the 3-month course, students showed improvement across all measures ( p < .001). The only outcomes that improved differentially between the Intervention and Control groups were the Questionnaire on Attitudes and Knowledge of ECT Attitudes and Knowledge scales ( p = .01). Word choice valence associated with ECT shifted favorably by endpoint ( p < .001). CONCLUSIONS: An educational intervention co-led by a psychiatric-mental health APRN had a significant impact on nursing students’ knowledge and perceptions of ECT. This approach can be readily implemented at other institutions. Future refinements will include the videotaped depiction of a simulated patient undergoing the consent, treatment, and recovery phases of ECT.

Current knowledge and attitudes of psychiatric nurses toward electroconvulsive therapy

“…The findings from this study underscore the need for increased education, training, and substantiate outcomes from previous studies (Adams, 2015; Kitay et al, 2020; Nitasha et al, 2017). Acquiring knowledge through in‐service education and possible nursing curriculum adjustment with emphasis on ECT may be needed to capture nurses who have inadequate knowledge and negative attitudes toward ECT treatment.…”

“…The lack of comprehensive ECT education in nursing schools may contribute to the reported less than ideal knowledge and attitudes of psychiatric nurses toward ECT. Increasing knowledge and acquiring experience in clinical practice about the ECT modality will improve both knowledge and positive attitudes toward ECT use (Kitay et al, 2020).…”

Treating Children With Physical Disabilities: A Video-Based Educational Resource Using Simulated Participants

“…We manually coded the words into three emotional valence categories. 27 , 28 Word clouds are commonly used in education research, as they can complement activities by visualizing underlying themes identified by learners. 29 …”

Teaching ECT to Medical Students

“…2,[9][10][11][12][13] Finally, two studies compare experiences with ECT with anesthesia or muscle relaxants (modified) and ECT without anesthesia or muscle relaxants (unmodified); in settings where unmodified ECT was still in wide use, exposure to the practice of modified versus unmodified ECT had little impact on trainee attitudes. 14,15 Most of the interventional studies show the impact of psychiatry clerkship alone, [16][17][18] direct participation or observation, 19 or single lectures, [20][21][22][23][24] surveying students before and after their experiences; it is apparent that any kind of direct exposure or didactic training appears to improve acceptance of ECT and increase knowledge while decreasing misconceptions about the procedure.…”

“…Most of the interventional studies show the impact of psychiatry clerkship alone, 16–18 direct participation or observation, 19 or single lectures, 20–24 surveying students before and after their experiences; it is apparent that any kind of direct exposure or didactic training appears to improve acceptance of ECT and increase knowledge while decreasing misconceptions about the procedure.…”