What are the ethical dilemmas in the decision‐making processes of nursing people given electroconvulsive therapy? A critical realist review of qualitative evidence

Abstract

Accessible Summary What is known on the subject? ECT is a treatment which has a long and complicated history. There is no consensus on its effectiveness and there is a great deal of polarized debate as to whether it should be used. MHNs are asked to work with people who are receiving ECT as part of their duties. What the paper adds to existing knowledge? The paper seeks to move beyond the polarized arguments and to consider how MHNs can work with people where ECT is being considered or administered as part of their treatment in a manner which satisfies their professional obligations. Implications for practice MHNs may need to broaden their understanding of ethics beyond the traditional biomedical ethics model of beneficence, non‐maleficence, justice and autonomy, as well as improving their understanding of social and political factors which may have an unseen effect of the use of ECT as a treatment in order to meet their professional obligations when working with people being administered ECT. Abstract INTRODUCTIONElectroconvulsive therapy (ECT) has a complex and contentious place in psychiatric care. Mental health nurses (MHNs) are of obligated to be part of this practice despite ethical concerns. AimTo consider the ethical dilemmas and decision‐making processes facing MHNs involved in the administration of ECT. MethodA critical realist review of the literature surrounding ethical considerations and ECT was undertaken using thematic analysis. FindingsFour key themes emerged: the MHN as an advocate and conflict in their role, issues surrounding consent, questionable efficacy and unknown method of action, side effects, and legal issues and clinical guidelines. DiscussionUsing a critical realist framework for understanding, the decision‐making process and ethical considerations are viewed as part of the empirical and actual parts of reality, while the potential for other, unseen causal powers to be at play is acknowledged. Implications for practiceMHNs need to ensure they have an adequate ethical underpinning to their practice to enable them to navigate contentious areas of practice such as ECT to practice effectively and preserve safety. This may require moving beyond the traditional biomedical model of ethics. Developing an appreciation of unseen causal factors is also an essential part of MHNs’ developing professional competency.

Advisory groups in realist reviews: Systematically mapping current research and recommendations for practice

“…40% ( n = 37) of the realist reviews cited use of an advisory group at some stage (as per the working definition for this study, notably other terminology was often reported) [14–17, 25–61]. 60% ( n = 56) did not mention the use of an advisory group [62–117]. Of those that did not mention an advisory group, seven reviews [62–64] did report participant involvement that did not fulfill the criteria of an advisory group, i.e., participants were used as data sources but did not advise on the review.…”

An audit and analysis of electro convulsive therapy patient information sheets used in local health districts in New South Wales Australia

“…This includes the right to choose or refuse treatment and respect for an individual's autonomy. Based on current evidence, and considering the manifest risks versus benefits of ECT, mental health nurses need to critically evaluate their role in this psychiatric practice, all the while ensuring they are acting in the best interests of individuals in their care (Sweetmore, 2022). This may require them to consider the language, content, accuracy, lens and balance of any information provided about ECT.…”