Perspectives on electroconvulsive therapy : the work of mental health nurses
Using grounded theory this study explored mental health nurses' perceptions of ECT and their role in the treatment process. 24 mental health nurses working in adult settings in two hospitals were surveyed through purposive, then theoretical sampling using non-participant observation followed by unstructured interviews. Three descriptive categories were developed 'perceptions', 'dramas' and 'dilemmas'. Perceptions comprise the sub-categories of 'involvement', 'patients', 'mental health nurses' images of ECT' and 'relationships', are related to each other. The three stages in the ECT drama requiring two types of role. Relational roles: 'information-giver', 'persuader' and 'supporter' and treatment roles: 'theatre work', 'gatekeeping' and 'forcing'. The nurse-patient relationship influences how the former roles are carried out. 'Theatre work' and 'gatekeeping' differentiates ward nurses from colleagues in the treatment area. The 'forcing' role involves both groups obscuring distinctions between them. Two types of dilemma emerged, first, role dissonance whilst in the treatment setting is unique to the ward nurse. The second, typified by concern about the nurses' relationship with the patient when this is perceived to be negatively influenced by a forcing event affects both groups of nurses. 'Being there' is the core category for understanding the nurse's relationship with the patient. Dimensional, it consists of three ideal type sub-categories 'engaged', 'present' and 'detached'. A humanistic relationship with the patient (engaged) at one end, to a distance (detached) relationship at the other with a position between these extremes 'present'. 'Being there' explains nurses' behaviour with their patients in the ECT drama, the roles acted, approach to difficulties encountered and, paradoxically, how this contributes to these. In circumstances of 'forcing' only 'present and 'detached' appear stable. Slipping is postulated as the basic social psychological process by which nurses move along the dimension hence the potential for variation for nurses managing their involvement with the patient.