Work and roles in the ECT clinic

Last Wednesday (May 14th 2014 ) I had the chance to speak at the 4th National Association of Lead Nurses in ECT (NALNECT) conference. ECT (electro-convulsive therapy) has been around since the 1930s. It’s sparingly used, typically as a treatment for severe depression and only after other interventions have been tried and found wanting. The procedure involves the use of electricity to induce a seizure, and is conducted under anaesthesia. In the UK there are standards for ECT clinics, which place particular emphasis on quality and safety.

I’m no expert in ECT as a treatment, but I do know something about work and roles and it was this that I spoke about at the NALNECT event. I suggested that, rather like the physical holding of patients and other restrictive practices, ECT might be thought of as an example of the mental health system’s ‘dirty work’. It arouses strong views, and may well be an area about which there is more heat than light. A quick pre-conference search on Scopus turned up just 100 articles at the intersection of ‘ECT’ and ‘nursing’, with only 12 citations attributed to authors in the UK. Amongst these I found this paper investigating nurses’ attitudes, and this paper reporting findings from an observational study of the ECT workplace.

At Wednesday’s event I also talked about the ECT clinic’s unusually complex division of labour. Where else do mental health nurses, psychiatrists, anaesthetists, operating department practitioners and health care assistants routinely work together? The main item at the NALNECT conference was a debate on nurse-led clinics, though there seemed to be a number of different versions of what this might actually look like. Large parts of the discussion centred on the technical: who might apply which bit of the machinery, and who might press which button. I pointed out that tasks have forever moved around in the mental health system, and that a bigger question may not be the physical handling and usage of the ECT kit but nursing’s possession of sufficient knowledge to sustain claims to jurisdiction.

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