Nursing Care for Electroconvulsive Therapy (ECT) Patients
A Comprehensive Guide for Nursing Students
Table of Contents
Introduction to Electroconvulsive Therapy (ECT)
Electroconvulsive therapy (ECT) is a medical treatment most commonly used in patients with severe major depression or bipolar disorder that has not responded to other treatments. It involves passing a carefully controlled electrical current through the brain to induce a brief seizure, which affects brain chemistry and can rapidly alleviate symptoms of certain mental health conditions.
Definition
Electroconvulsive therapy (ECT) is a physical therapy in which electrical current is passed to the brain via electrodes to produce generalized seizures for therapeutic purposes. Modern ECT is performed under general anesthesia with muscle relaxation to ensure patient comfort and safety.
ECT remains one of the most effective treatment modalities for patients with treatment-resistant depression and other treatment-resistant mental health disorders. Studies support the efficacy and safety of this treatment, with response rates of 80-90% for patients receiving it as a first-line treatment and 50-60% for patients who have had multiple unsuccessful medication trials.
Historical Context and Modern Practice
While ECT has been in use for over 70 years, modern ECT bears little resemblance to its historical portrayal in media. Contemporary ECT is performed with:
- General anesthesia
- Muscle relaxants to prevent physical injury
- Oxygenation during the procedure
- Brain wave monitoring (EEG)
- Vital sign monitoring throughout
- Brief controlled electrical stimulus
Nursing Role in ECT
Psychiatric-mental health nurses (PMH) provide individualized care for patients receiving ECT. The nurse’s multifaceted role includes:
- Providing education and emotional support
- Pre-treatment planning and assessment
- Preparing and monitoring the patient during the procedure
- Post-treatment care and evaluation
- Patient advocacy and stigma reduction
- Family education and support
Indications and Contraindications for ECT
Primary Indications for ECT
ECT may be considered as a primary treatment (first-line treatment) for certain conditions, especially when rapid response is needed or when medications are contraindicated:
Major Indications
- Severe major depression with or without psychotic features
- Acute mania
- Bipolar disorder (depressive or manic phase)
- Catatonia
- Schizophrenia with mood component
Secondary Indications
- Treatment-resistant psychiatric disorders
- Patients at risk for severe self-harm or suicide
- Need for rapid symptom improvement
- Intolerance to medication side effects
- History of positive response to ECT
Special Populations
ECT can be safely administered in special populations with proper precautions:
- Geriatric patients (often well-tolerated)
- Pregnant women (when benefits outweigh risks)
- Postpartum patients
- Those unable to tolerate psychotropic medications
- Individuals under 18 (with special considerations)
Relative Contraindications and Considerations
Currently, there are no absolute contraindications for ECT. However, the following conditions require careful evaluation and specialized precautions:
- Recent myocardial infarction or stroke
- Space-occupying brain lesions or increased intracranial pressure
- Cerebral aneurysm
- Unstable cardiovascular conditions
- Anticoagulation therapy
- Implanted devices (pacemakers, deep brain stimulators, cochlear implants)
- Severe pulmonary disease
Pre-treatment Nursing Care
Patient Assessment and Preparation
Thorough pre-treatment nursing assessment and preparation are essential for safe ECT administration:
Physical Preparation
- NPO status (no food or drink) for 6-8 hours before ECT
- IV fluid administration for adequate hydration
- Ensure clean, dry hair for proper electrode contact
- Remove all metal objects, jewelry, hairpins, dentures, and contact lenses
- Have patient void before the procedure
- Dress patient in hospital gown (may wear underwear/pajama bottoms)
- Document baseline vital signs and mental status
Medication Management
- Withhold anticonvulsants as ordered (may interfere with seizure induction)
- Hold benzodiazepines as directed (raise seizure threshold)
- Hold lithium as directed (increases cognitive side effects)
- May administer morning cardiac medications with small sips of water
- Pre-emptive medications for headache/nausea if needed
- Continue antidepressant medications as directed
Documentation and Consent
- Verify informed consent is obtained and documented
- Ensure H&P (history and physical) is current (within 30 days)
- Complete pre-ECT nursing assessment form
- Document baseline cognitive assessment
- Verify pre-procedure laboratory results are available
- Confirm that legal documents are in order (guardianship, court orders if applicable)
Pre-Treatment Education
Patient education is crucial before ECT begins:
- Explain the ECT procedure in simple terms
- Review what to expect before, during, and after the procedure
- Discuss common side effects and their management
- Address common fears and misconceptions
- Explain the typical course of treatment (usually 6-12 sessions)
- Provide written materials and educational resources
- Include family members in education when appropriate
ECT Procedure and Intra-procedure Nursing Care
ECT Procedure Overview
An ECT session typically lasts about 15-30 minutes, with the actual stimulus lasting only a few seconds. The procedure involves:
Treatment Team
- Psychiatrist or credentialed ECT provider
- Anesthesiologist or CRNA
- Nursing staff
- Support personnel
Equipment
- ECT machine (FDA-approved device)
- Anesthesia equipment
- Airway management supplies
- Monitoring equipment (ECG, BP, pulse oximetry)
- EEG monitoring for seizure quality/duration
- Emergency equipment readily available
Types of ECT Administration
- Electrode Placement:
- Bilateral (bifrontotemporal) – more effective but higher cognitive side effects
- Right unilateral – fewer cognitive side effects
- Bifrontal – intermediate cognitive effects
- Stimulus Parameters:
- Brief pulse – conventional waveform
- Ultrabrief pulse – may reduce cognitive side effects
Step-by-Step Procedure
- Patient positioned supine on stretcher with a small pillow under the lumber curve
- Anesthesia induction (typically with a short-acting agent like propofol, methohexital, or etomidate)
- Administration of muscle relaxant (usually succinylcholine)
- Oxygenation and ventilation support throughout the procedure
- Placement of bite block to prevent oral injury
- Application of electrode gel and placement of treatment electrodes
- Brief electrical stimulus delivered
- Monitoring of seizure activity (motor seizure and EEG)
- Continued support until spontaneous respiration resumes
- Transfer to recovery area when stable
Intra-procedure Nursing Care
- Assist with patient positioning and safety
- Support airway management as needed
- Monitor vital signs continuously
- Observe and document seizure characteristics:
- Duration (typically 30-90 seconds)
- Quality of motor and EEG seizure
- Presence of tonic phase followed by clonic phase
- Provide suction as needed
- Participate in “time out” procedure for patient safety
- Document all aspects of the procedure
Post-treatment Nursing Care
Immediate Recovery Phase
Recovery from ECT occurs in phases, beginning with the immediate post-ictal period:
Level 1 Recovery
- Position patient in recovery position (side-lying)
- Provide continuous monitoring of vital signs
- Maintain airway patency; suction secretions as needed
- Assess level of consciousness
- Monitor for emergence from anesthesia
- Administer supplemental oxygen as needed
Common Post-ECT Issues
- Confusion and disorientation
- Headache (administer analgesics as ordered)
- Muscle aches
- Nausea (administer antiemetics as ordered)
- Temporary memory impairment
- Agitation (may require reorientation or medication)
Extended Recovery and Monitoring
- Continue vital sign monitoring per protocol
- Reorient patient frequently to person, place, and time
- Assess gag reflex before offering fluids
- Allow patient to rest for 30-60 minutes after procedure
- Conduct post-procedure cognitive assessment
- Evaluate for adverse effects
- Provide breakfast and hydration when appropriate
Discharge Criteria for Outpatients
Outpatients must meet these criteria before discharge:
- Stable vital signs close to baseline
- Return of gag reflex
- Orientation to person, place and time
- Able to ambulate with minimal assistance
- Absence of significant side effects
- Presence of responsible adult to transport and stay with patient
- Written discharge instructions reviewed and provided
- Follow-up appointment scheduled
Safety Considerations
After ECT, patients require special safety precautions:
- Fall precautions due to potential unsteady gait
- No driving for 24 hours after treatment
- No important decision-making on treatment days
- Close supervision for outpatients
- Regular reassessment for inpatients returning to unit
Nursing Diagnoses and Care Plans for ECT Patients
The following are 10 key nursing diagnoses with detailed care plans for patients undergoing ECT:
1. Risk for Injury related to altered consciousness during post-ictal state and cognitive changes
Assessment Data
- Altered consciousness state during recovery from anesthesia
- Potential disorientation and confusion
- Unsteady gait
- Memory impairment affecting safety awareness
- Risk of falls due to post-procedure instability
Expected Outcomes
- Patient will remain free from injury during the ECT treatment course
- Patient will demonstrate safe mobility with assistance as needed
- Patient will follow safety instructions appropriate to cognitive status
Nursing Interventions
| Interventions | Rationales |
|---|---|
| Implement fall precautions including bed in low position, side rails up when appropriate, call bell within reach | Prevents falls during periods of confusion and unsteady gait after ECT |
| Supervise ambulation following ECT until steadiness is demonstrated | Provides physical support and prevents falls due to post-procedure gait disturbances |
| Orient patient frequently to surroundings | Reduces confusion and improves safety awareness |
| Create a safe environment by removing potential hazards | Minimizes risk of injury from environmental factors |
| Assess patient’s level of consciousness and orientation before allowing independent activities | Ensures patient has recovered sufficiently to perform activities safely |
Evaluation
- Patient remained free from injury during and after ECT treatment
- Patient follows safety instructions when oriented
- Patient accepts assistance with mobility until stable
2. Ineffective Memory related to ECT-induced cognitive changes
Assessment Data
- Difficulty remembering recent events
- Short-term memory deficits
- Confusion about time sequence of events
- Difficulty recalling information presented
- Memory gaps around the time of treatment
Expected Outcomes
- Patient will demonstrate understanding that memory changes are typically temporary
- Patient will utilize compensatory strategies to manage memory deficits
- Patient will show gradual improvement in memory function after completion of ECT course
Nursing Interventions
| Interventions | Rationales |
|---|---|
| Provide a memory aid journal or notebook for patient to record important information | Offers external memory support and helps bridge memory gaps |
| Orient patient to time, place, and person with each encounter | Reinforces orientation and helps establish reality context |
| Encourage family to maintain a visitor log with notes about their visits | Provides memory cues and continuity for the patient |
| Provide consistent daily routines and environmental cues | Reduces confusion and supports functioning despite memory deficits |
| Reassure patient that memory issues are expected and typically improve after completing treatment course | Reduces anxiety about cognitive changes and provides realistic expectations |
| Monitor memory function using standardized tools | Provides objective assessment of cognitive changes and recovery |
Evaluation
- Patient uses memory aids effectively
- Patient demonstrates reduced distress about memory changes
- Patient shows improvement in cognitive functioning over time
3. Anxiety related to ECT procedure and uncertain outcomes
Assessment Data
- Expressed concerns about ECT
- Increased vital signs
- Restlessness or agitation
- Difficulty sleeping before scheduled treatments
- Verbalized fears about the procedure
- Physical symptoms of anxiety (trembling, sweating)
Expected Outcomes
- Patient will verbalize reduced anxiety about the ECT procedure
- Patient will demonstrate use of effective coping strategies
- Patient will exhibit physiological indicators of reduced anxiety
Nursing Interventions
| Interventions | Rationales |
|---|---|
| Provide clear, accurate information about the ECT procedure | Knowledge reduces fear of the unknown and corrects misconceptions |
| Establish therapeutic relationship through active listening and presence | Creates trust and provides emotional support |
| Teach relaxation techniques (deep breathing, progressive muscle relaxation) | Provides practical tools to manage anxiety symptoms |
| Minimize waiting time on treatment days | Reduces anticipatory anxiety |
| Administer prescribed anxiolytic medications as ordered | Provides pharmacological support for severe anxiety |
| Encourage expression of fears and concerns | Allows opportunity to address specific anxieties |
Evaluation
- Patient reports decreased anxiety levels
- Patient demonstrates use of relaxation techniques
- Patient exhibits normal vital signs before procedure
- Patient approaches subsequent treatments with less apprehension
4. Acute Pain related to headache, muscle aches, and jaw discomfort following ECT
Assessment Data
- Reports of headache following treatment
- Complaints of muscle soreness or myalgia
- Jaw discomfort or temporomandibular joint (TMJ) pain
- Nonverbal pain cues (facial grimacing, guarding)
- Elevated vital signs associated with pain
Expected Outcomes
- Patient will report pain at acceptable levels (≤3 on 0-10 scale) following ECT
- Patient will identify effective strategies for pain management
- Patient will demonstrate improved comfort following interventions
Nursing Interventions
| Interventions | Rationales |
|---|---|
| Assess pain using appropriate scale and document characteristics | Provides baseline for evaluation and guides intervention selection |
| Administer prophylactic analgesics as ordered (acetaminophen, NSAIDs) | Preemptive pain management reduces severity and improves comfort |
| Apply cold compress to forehead or temples for headache | Provides non-pharmacological pain relief through vasoconstriction |
| Position patient comfortably and assist with gentle movement | Reduces muscle strain and associated discomfort |
| Ensure adequate hydration before and after ECT | Reduces headache intensity often associated with dehydration |
| Document effectiveness of interventions and adjust plan accordingly | Enables evaluation of treatment efficacy and guides future interventions |
Evaluation
- Patient reports decreased pain intensity following interventions
- Patient identifies effective pain management strategies
- Patient demonstrates improved comfort and functional ability
5. Risk for Aspiration related to decreased level of consciousness and impaired gag reflex
Assessment Data
- Decreased level of consciousness following anesthesia
- Temporarily impaired gag and swallowing reflexes
- Increased oral secretions
- Potential nausea post-procedure
- Risk factors: NPO status violations, GERD
Expected Outcomes
- Patient will maintain patent airway throughout recovery
- Patient will demonstrate intact swallowing and gag reflexes before oral intake
- Patient will remain free from aspiration during recovery
Nursing Interventions
| Interventions | Rationales |
|---|---|
| Position patient in side-lying recovery position until fully awake | Promotes drainage of secretions and prevents aspiration if vomiting occurs |
| Verify NPO status before procedure | Reduces risk of aspiration of stomach contents |
| Suction airway as needed to remove secretions | Maintains airway patency and removes aspiration hazards |
| Assess gag reflex before offering any food or fluids | Ensures patient can protect airway before oral intake |
| Elevate head of bed 30-45 degrees when patient begins to awaken | Reduces risk of regurgitation and aspiration |
| Administer antiemetics as ordered for nausea | Reduces risk of vomiting and associated aspiration |
Evaluation
- Patient maintains patent airway throughout recovery
- Patient demonstrates intact gag reflex before oral intake
- Patient tolerates oral intake without complications
- Patient remains free from signs of aspiration
6. Ineffective Coping related to stress of treatment and underlying mental health condition
Assessment Data
- Verbalized inability to cope with treatment stress
- Symptoms of underlying psychiatric condition
- Emotional lability
- Expressed feelings of helplessness
- Poor concentration and decision-making
- Limited use of support systems
Expected Outcomes
- Patient will identify and utilize effective coping strategies
- Patient will verbalize decreased stress related to ECT treatment
- Patient will engage with support systems appropriately
Nursing Interventions
| Interventions | Rationales |
|---|---|
| Assess current coping strategies and their effectiveness | Identifies existing strengths and areas for improvement |
| Assist in identifying personal strengths and previous successful coping methods | Builds on existing resources and reinforces self-efficacy |
| Teach stress reduction techniques | Provides practical tools for immediate stress management |
| Encourage involvement of family and support system | Expands available resources for emotional support |
| Provide positive reinforcement for adaptive coping behaviors | Strengthens desired behaviors through recognition |
| Facilitate referrals to support groups or counseling services | Connects patient with additional coping resources |
Evaluation
- Patient demonstrates use of effective coping strategies
- Patient reports reduced stress levels related to treatment
- Patient appropriately utilizes available support systems
- Patient shows improved emotional regulation
7. Deficient Knowledge related to ECT procedure, effects, and self-care requirements
Assessment Data
- Verbalized misconceptions about ECT
- Questions about treatment process
- Expressed uncertainty about self-care needs
- Limited previous experience with ECT
- Anxiety related to lack of information
Expected Outcomes
- Patient will verbalize accurate understanding of ECT procedure
- Patient will demonstrate knowledge of appropriate self-care activities
- Patient will identify expected effects and potential side effects of ECT
Nursing Interventions
| Interventions | Rationales |
|---|---|
| Assess current knowledge level and learning needs | Establishes baseline and identifies specific areas requiring education |
| Provide written and verbal information about ECT procedure | Offers multiple learning modalities and reference materials |
| Correct misconceptions about ECT in a supportive manner | Addresses myths and stigma with accurate information |
| Teach specific self-care requirements (NPO status, activity restrictions) | Promotes adherence to safety guidelines and treatment protocols |
| Review common side effects and management strategies | Prepares patient for expected experiences and reduces anxiety |
| Include family/support persons in education sessions | Extends knowledge base to support system for reinforcement |
Evaluation
- Patient accurately describes ECT procedure and rationale
- Patient demonstrates understanding of self-care requirements
- Patient identifies common side effects and management strategies
- Patient articulates realistic expectations about treatment outcomes
8. Disturbed Thought Processes related to post-ictal confusion and cognitive changes
Assessment Data
- Disorientation to time, place, or person
- Confusion following treatment
- Difficulty with concentration
- Impaired decision-making
- Disrupted thought patterns
Expected Outcomes
- Patient will return to baseline cognitive function between treatments
- Patient will demonstrate progressive improvement in orientation
- Patient will recognize and report changes in thought processes
Nursing Interventions
| Interventions | Rationales |
|---|---|
| Frequently orient patient to time, place, person, and situation | Reinforces reality orientation and reduces confusion |
| Provide environmental cues (clocks, calendars, familiar objects) | Supports orientation through visual reminders |
| Use clear, simple communication | Reduces cognitive processing demands during periods of confusion |
| Monitor cognitive status using standardized assessment tools | Provides objective measurement of cognitive changes over time |
| Allow sufficient time for patient to process information and respond | Accommodates temporary cognitive slowing |
| Minimize unnecessary stimuli in environment | Reduces sensory overload that can worsen confusion |
Evaluation
- Patient demonstrates improved orientation with each assessment
- Patient returns to baseline cognitive function between treatments
- Patient communicates needs effectively despite temporary thought disturbances
9. Fear related to ECT procedure, stigma, and potential memory loss
Assessment Data
- Expressed fears about ECT procedure
- Concern about stigma associated with ECT
- Fear of permanent memory loss
- Physiologic signs of fear (increased heart rate, BP)
- Avoidance behaviors or resistance to treatment
Expected Outcomes
- Patient will verbalize reduced fear regarding ECT procedure
- Patient will demonstrate decreased physiological signs of fear
- Patient will express realistic understanding of memory effects
Nursing Interventions
| Interventions | Rationales |
|---|---|
| Provide accurate information about modern ECT procedures | Corrects misconceptions and reduces fear of the unknown |
| Explore specific fears through therapeutic communication | Identifies exact concerns for targeted intervention |
| Offer realistic information about memory effects and their typically temporary nature | Provides accurate expectation management regarding cognitive side effects |
| Use anxiety reduction techniques before treatments | Decreases acute fear response through relaxation methods |
| Maintain consistent care providers when possible | Builds trust and reduces fear through familiarity |
| Connect patient with others who have had positive ECT experiences when appropriate | Provides peer support and reduces stigma through shared experience |
Evaluation
- Patient verbalizes decreased fear about ECT procedure
- Patient demonstrates reduced physiological signs of fear
- Patient discusses ECT with realistic understanding rather than fear-based misconceptions
10. Risk for Decreased Cardiac Output related to physiological effects of ECT on cardiovascular system
Assessment Data
- Normal physiologic response includes initial parasympathetic stimulation (bradycardia) followed by sympathetic response (tachycardia, hypertension)
- Pre-existing cardiac conditions
- Use of medications affecting cardiac function
- Changes in vital signs during procedure
Expected Outcomes
- Patient will maintain stable cardiac function during and after ECT
- Patient will demonstrate return to baseline cardiovascular parameters post-procedure
- Patient will remain free from cardiac complications
Nursing Interventions
| Interventions | Rationales |
|---|---|
| Obtain baseline cardiovascular assessment before each treatment | Establishes reference point for comparison and identifies pre-existing issues |
| Monitor vital signs continuously during procedure and frequently during recovery | Allows for early detection of cardiovascular complications |
| Administer cardiac medications as ordered | Maintains cardiovascular stability during sympathetic stimulation |
| Have emergency medications and equipment readily available | Ensures prompt response to cardiac emergencies |
| Position patient to optimize cardiac output during recovery | Supports hemodynamic stability |
| Document cardiovascular response to treatment | Provides data for evaluating patterns and planning future treatments |
Evaluation
- Patient maintains stable vital signs during and after ECT
- Patient returns to baseline cardiovascular status after recovery
- Patient remains free from cardiac complications
Health Education for Family Members
Understanding ECT: Information for Families
Family support and understanding are crucial for patients undergoing ECT. The following education points help family members support their loved ones through the ECT process:
What is ECT and How Does It Work?
- ECT is a safe and effective medical treatment that uses electricity to cause a controlled seizure to improve a patient’s mood
- Modern ECT is performed under anesthesia with muscle relaxation
- ECT works by affecting neurotransmitters and brain activity patterns
- It is most commonly used for severe depression, bipolar disorder, and certain other psychiatric conditions
- ECT is typically administered 2-3 times per week for a total of 6-12 treatments
The Family’s Role During Treatment
- Provide emotional support and reassurance
- Help communicate changes in the patient’s condition to the treatment team
- Assist with transportation and logistics for outpatients
- Maintain a visitor log and journal for patient reference
- Help with orientation after treatments
- Ensure safety at home between treatments
What to Expect During the ECT Process
Before Treatment
- Patient will need to fast (NPO) from midnight before treatment
- Morning medications may be given with small sips of water as directed
- Patient will change into a hospital gown
- Jewelry, dentures, and other items will be removed
- Family members may accompany patient to treatment area
- Consent forms will be reviewed and signed
During Treatment
- Family will wait outside treatment room during procedure
- Treatment typically takes 15-30 minutes total
- Patient receives brief anesthesia and muscle relaxant
- Monitoring equipment tracks vital signs and brain activity
- The actual electrical stimulus lasts only a few seconds
- Medical team monitors recovery from anesthesia
After Treatment
- Patient will be in recovery for about 20-30 minutes
- Family may join patient in recovery when appropriate
- Patient will likely be confused and drowsy initially
- Patients may return to normal activities later in the day
- Outpatients must be driven home and supervised
- No driving or important decisions on treatment days
Managing Common Side Effects
Family members should be prepared to help manage these common side effects of ECT:
| Side Effect | Management Strategies |
|---|---|
| Confusion and Disorientation |
|
| Memory Problems |
|
| Headache and Muscle Pain |
|
| Nausea |
|
Supporting Recovery and Monitoring Progress
When to Contact Healthcare Providers
Family members should contact healthcare providers if the patient experiences:
- Severe or worsening headache not relieved by medications
- Prolonged confusion that doesn’t improve
- Significant worsening of psychiatric symptoms
- New or unusual physical symptoms
- Suicidal thoughts or behaviors
- Falls or injuries
- Inability to eat, drink, or take medications
Important Reminders for Families
- Most patients need several treatments before significant improvement is seen
- Some patients may appear to improve physically before they feel better emotionally
- Initial positive responses may fade between early treatments but gradually last longer
- Provide feedback to the treatment team about your observations of the patient’s progress
- Be patient and supportive throughout the treatment course
- Encourage completion of the full treatment course as prescribed
- Help reduce stigma by sharing accurate information about modern ECT
Supporting Your Loved One
Practical ways to support someone receiving ECT:
- Create a journal where visitors can sign in and leave notes to help with memory
- Write down important information like dates, addresses, and phone numbers
- Provide gentle reminders about day and date, explaining that confusion is expected
- Communicate any concerns or observations to the nursing staff
- Help maintain medication schedules and follow-up appointments
- Be present during treatment days when possible
- Offer encouragement about treatment progress
- Participate in discharge planning and aftercare
References
- American Psychiatric Association (2001). The Practice of Electroconvulsive Therapy, Recommendations for Treatment, Training, and Privileging: A Task Force Report of the American Psychiatric Association, Second Edition. American Psychiatric Association Publishing.
- American Psychiatric Nurses Association (APNA) (2021). Position Paper: Electroconvulsive Therapy. American Psychiatric Nurses Association (APNA.org).
- Salini, D., Goldin, D., Valdes, B. & DeSantis, J. (2023). Electroconvulsive therapy for treatment-resistant depression: dispelling the stigma. Journal of Psychosocial Nursing and Mental Health Services, 61(6), 11-17.
- Thirthalli, J., Sinha, P. & Sreeraj, V. (2023). Clinical practice guidelines for the use of electroconvulsive therapy. Indian Journal of Psychiatry, 65(2), 258-269.
- Joung K.W., Park, D.H., Jeong, C.Y., Yang, H.S. (2022). Anesthetic care for electroconvulsive therapy. Anesthesia Pain Med, 17(2), 145-156.
- Kavanagh A, McLoughlin DM. (2009). Electroconvulsive therapy and nursing care. British Journal of Nursing, 18(22), 1370-7.
- Burns CM, Stuart GW. (1991). Nursing care in electroconvulsive therapy. Psychiatric Clinics of North America, 14(4), 971-88.
- Mankad, M. (2019). Electroconvulsive therapy: Overview, Preparation, Technique. Medscape.
- Poole, J. & DAlessandro, T.M. (2020). ECT: Dispelling the myths and focusing on facts. American Nurse.
- Reti, I., Walker, M., Pulia, K., Gallegos, J., Jayaran, G. & Vaidya, P. (2012). Safety considerations for outpatient electroconvulsive therapy. Journal of Psychiatric Practice, 18(2), 130-136.