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

Abstract

INTRODUCTION\nElectroconvulsive 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.\n\n\nAIM\nTo consider the ethical dilemmas and decision-making processes facing MHNs involved in the administration of ECT.\n\n\nMETHOD\nA critical realist review of the literature surrounding ethical considerations and ECT was undertaken using thematic analysis.\n\n\nFINDINGS\nFour 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.\n\n\nDISCUSSION\nUsing 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.\n\n\nIMPLICATIONS FOR PRACTICE\nMHNs 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 bio-medical model of ethics. Developing an appreciation of unseen causal factors is also an essential part of MHNs developing professional competency.\n\n\nRELEVANCE STATEMENT\nMHNs are involved in the care of people receiving ECT. Due to the contentious nature of ECT treatment and the complex ethical issues, they may be placed in situations which are professionally tricky to navigate. MHNs may need to broaden their ethical framework beyond the biomedical model and to improve their understanding of unseen causal factors at play to meet their professional obligations in relation to practicing effectively and preserving safety.