Experiences of Mental Health Nurses in Providing Care to Patients Receiving Electroconvulsive Therapy in South Korea

ABSTRACT

In recent years, the demand for electroconvulsive therapy has been increasing in South Korea. However, there are problems due to mental health nurses' lack of understanding about electroconvulsive therapy and the absence of systematic education. This study aimed to explore mental health nurses' experiences of providing care to patients receiving electroconvulsive therapy in South Korea. We used content analysis to analyse the data collected from focus group interviews with 22 mental health nurses working in mental health hospitals. The results revealed four themes and 10 subthemes. More specifically, the results showed that mental health nurses consider themselves helpers in recovery. They pursue the physical and emotional well‐being of patients receiving electroconvulsive therapy and strive to ensure that patients receive electroconvulsive therapy comfortably and safely. However, contentious issues such as concerns about patient dignity and autonomy lead to differing perceptions and attitudes towards electroconvulsive therapy and cause internal conflict during therapeutic interactions. Furthermore, insufficient education on electroconvulsive therapy leads to a lack of knowledge and difficulties in fulfilling the role of an information provider. The shortage of coping measures and support systems for issues such as extensive adverse effects and restricted medication increases the work burden immensely. These findings can serve as foundational data for the development of standardised nursing practices and systematic education for electroconvulsive therapy.

1. Introduction

Electroconvulsive therapy (ECT) is a medical treatment that was started in the 1930s. Despite being widely used worldwide, it remains a contentious topic (Gazdag and Ungvari 2019; Kring, Bergholt, and Midtgaard 2018; Sweetmore 2022). This is because the mechanisms of ECT remain unclear, opinions about its efficacy and safety are divided, and multiple rounds of general anaesthesia and electrical stimulation can cause adverse effects, such as confusion and amnesia (Munkholm, Jørgensen, and Paludan‐Müller 2021; Wand, Isobel, and Kemp 2024; Wells, Hancock, and Honey 2021). Therefore, it is essential to ensure the validity by considering the benefits and harms of ECT, comprehensively explain the process to patients and obtain their consent before proceeding. To achieve this, it is essential to establish a foundation of evidence through comprehensive and multi‐faceted research.

Mental health nurses (MHNs) perform an important role in ECT. Before and after the procedure, MHNs educate patients about the therapy and provide emotional support to them. They also help in preparing for the therapy and managing adverse effects. However, studies have shown that nurses have a lack of knowledge and negative attitudes towards ECT and systematic ECT education and training is lacking in nursing curricula (Ezeobele et al. 2022; Sweetmore 2022). Insufficient knowledge and stigma among health professionals can affect patients' perceptions of ECT, which can make it difficult to admit patients who require treatment and hamper treatment effects and prognosis (Sarma et al. 2023). Wand, Isobel, and Kemp (2024) reported that patients receiving ECT are provided insufficient and inaccurate information about the alternative treatments and the safety, efficacy and side effects of ECT, and Clarke, Barnes, and Ross (2018) reported the use of passive coercion in obtaining consent from patients. Conversely, nurses in Ireland have reported that patients now receive more information about ECT than they did before and that they have more authority in deciding whether to continue ECT (Lonergan, Timmins, and Donohue 2021). When ECT information sheets were analysed at 13 institutions in Australia, the content and structure were found to differ significantly (Wand, Isobel, and Kemp 2024). These findings demonstrate differences in ECT‐related practices among institutions and countries and highlight the urgent need for standardisation of care for ECT patients.

In the last 10 years, there has been a persistent increase in the use of ECT in South Korea. Guidelines on ECT were developed in the country in 2021 with support from the Ministry of Health and Welfare (National Center for Mental Health 2021). However, the content related to nursing care is extremely superficial and has major shortcomings. This makes it necessary to develop systematic guidelines on the care of patients receiving ECT. To do this, it is essential to comprehensively explore the perspectives and experiences of nurses, particularly MHNs, related to providing care to patients receiving ECT. However, studies so far have focused mostly on clinicians' perspectives; research remains scant in the field of nursing, and there has been no pertinent research in South Korea.

Therefore, this study conducted an in‐depth investigation of MHNs' perspectives on and experiences of providing care to patients receiving ECT. With this objective, we aimed to provide fresh insight on nursing care services for ECT patients, help improve treatment efficacy and safety and provide evidence for the development of systematic education and practice.

2. Methods

2.1. Design

Employing a qualitative exploratory approach, we conducted focus group interviews (FGIs) and used content analysis methods (Elo and Kyngäs 2008) to explore MHNs' experiences in providing care to patients receiving ECT. Throughout the study process, we adhered to the COREQ checklist (Tong, Sainsbury, and Craig 2007), a strict conceptual framework for qualitative research.

2.2. Data Collection

To ensure that the interviewees could talk sufficiently about the experience of providing care to ECT patients, we conducted FGIs with MHNs who currently employed for more than 1 year in a mental health institution where ECT is administered. We explained the study objectives and methods to nursing managers at four mental health hospitals in S city and J province where ECT is conducted in South Korea. After obtaining their permission, we posted recruitment notices in the wards and on online message boards. Among those who saw the recruitment notice and were voluntarily willing to participate in the study, we recruited 22 nurses from four hospitals (three advanced general hospitals and one psychiatric specialist hospital). Four FGIs lasting 60–90 min were conducted between September and November 2023 using a video conferencing programme. Before the interviews, the participants were asked to take the Questionnaire on Attitudes and Knowledge (QuAKE) Scale (Lutchman et al. 2001) to assess their knowledge and attitudes towards ECT. In this study, we used the QuAKE scale as employed by Ezeobele et al. (2022). The QuAKE scale evaluates knowledge regarding ECT through 11 items covering topics such as clinical indications, efficacy, contraindications, procedures, clinical and legal aspects and side effects. Additionally, the QuAKE scale assesses attitudes towards ECT with 15 items addressing its efficacy, potential adverse effects, appropriate use, decision‐making in treatment planning and ethical considerations. One investigator with ample experience of FGIs conducted the interviews based on the questions in Table 1. Another investigator took live notes on the overall atmosphere of the interviews and participants' nonverbal responses. Additional questions were asked when required. All interviews were recorded, and the content was transcribed and analysed directly by the interviewer immediately after the interview. After four interviews, the researchers confirmed that the saturation point had been reached and stopped data collection.

TABLE 1.

Interview questions.

Opening question	Please introduce yourself
Introductory question	What did you think about electroconvulsive therapy as a treatment before becoming a nurse?
Transition question	How was your most recent experience of providing care to patients receiving electroconvulsive therapy?
Key questions	How have your experiences been in providing care to patients receiving electroconvulsive therapy?
	What change does current electroconvulsive therapy induce in patients?
	What preparations have you taken to provide care to patients receiving electroconvulsive therapy?
Ending question	If there is anything that has been missed from our conversation or anything you would like to share with the investigator, please go ahead

2.3. Data Analysis

The collected data were analysed using the inductive content analysis method of Elo and Kyngäs (Elo and Kyngäs 2008). First, the transcribed content was read multiple times to grasp its essence and the flow of the interviews. Repeated words and phrases were highlighted, organised and extracted as codes. These codes were categorised based on their features, and the categories were assigned names that reflected their meaning and relevance. Finally, we derived abstract categories reflecting the core content and organised them into phenomena that fit the study objective. The results were organised into a table to clarify the derived themes and related concepts and verify the validity and suitability of data analysis. To establish trustworthiness, member checking was performed on the derived themes after the last interview and data analysis, and interviews were continued until saturation was achieved. To increase the reliability of the initial analysis, several meetings were held between the researchers, and all stages of the analysis process were recorded to enable retracing.

2.4. Ethical Considerations

Before starting the study, the methods were reviewed by the IRB at the researchers' affiliated institution (IRB No. JBNU 2023‐08‐013‐001). Before obtaining their written consent, the study objectives and procedures were explained to the participants. They were also informed that their personal information would be protected, that they could withdraw from the study at any time without any consequences and that the collected data would be used for only research purposes. After completing the study, the participants were given a gift voucher as a token of appreciation.

3. Results

3.1. Characteristics of the Participants

There were 20 female participants and two male participants (Table 2). Most participants were 20–29 years old (n = 13). Most participants had less than 5 years of experience of working in the psychiatry department (n = 13), while the least number of participants had more than 10 years of this experience (n = 3). Participants' scores concerning the knowledge of ECT ranged from 5 to 11, and the mean score was 8.64 from a total score of 11 (Table 3). Their scores ranged from 7 to 15 regarding the attitude towards ECT, and the mean score was 12.18 out of a total of 15. Detailed scores are shown in Table 4.

TABLE 2.

Demographic characteristics of the participants.

Characteristic	N
Sex
Female	20
Male	2
Age (years)
20–29	13
30–39	7
40–49	1
50–59	1
Education level
Bachelor's degree	18
Master's degree	3
Doctoral degree	1
Experience of working as a nurse (years)
<5	7
5–10	9
≥10	6
Experience of working in the psychiatry department (years)
<5	13
5–10	6
≥10	3
Mental health nurse qualification
Yes	11
No	11

TABLE 3.

Participants' knowledge of and attitude towards electroconvulsive therapy.

	Nurse
Knowledge mean score (standard deviation)/total score Min–Max	8.64 (2.01)/11 5–11
Attitude mean score (standard deviation)/total score Min–Max	12.18 (1.97)/15 7–15

TABLE 4.

Results of Questionnaire on Attitudes and Knowledge Scale.

Knowledge items	(% Correct)
ECT should only be given to a patient who can eat and drink adequately	81.8
Patients must stop all medication before they can be given ECT	100.0
The use of ECT is covered in the Mental Health Act	63.6
Relatives need to give consent before ECT can be given	36.4
Patients cannot be given ECT against their will	31.8
Patients need to have nothing by mouth from the night before	77.3
Voltage used is in the order of 500 volts	77.3
ECT is appropriately used to treat depression	95.5
ECT is appropriately used to treat anorexia nervosa	54.5
Common side effects of ECT permanent memory impairment, broken bones and brain damage	86.4
ECT must not be given to those with the following conditions: Dementia, pregnancy and brain tumours	59.1

Attitude items	% Agree	% Disagree
1. Would consider ECT as treatment option for friend/relative	68.2	31.8
2. Major surgery is more dangerous than ECT	95.5	4.5
3. ECT is more likely to be beneficial than harmful	90.9	9.1
4. ECT is usually used appropriately	100.0	0.0
5. Psychiatrists take other members of staffs' views into account when deciding on ECT	72.7	27.3
6. Patients sufficiently informed about likely effects and side‐effects	95.5	4.5
7. Imagining myself having ECT is more worrying than the thought of having surgery for appendicitis	22.7	77.3
8. ECT should only be used as a last resort	36.4	63.6
9. It is the induced seizure that I find most worrying about ECT	63.6	36.4
10. Psychiatrists use ECT because they don't know how else to treat the patient	13.6	86.4
11. I find the most disturbing aspect of ECT to be the use of electricity	54.5	45.5
12. ECT is a cruel treatment	4.5	95.5
13. There is real proof that ECT works	100.0	0.0
14. Although the patient may recover from ECT, he/she will never be the same for having it	9.1	90.9
15. In this day of modern medicine ECT should be banned	0.0	100.0

Note: ‘Agree’ indicates positive and ‘disagree’ indicates negative attitudes except for item numbers 12, 14 and 15 where the reverse is the case due to how the questions were designed on the QuAKE scale.

3.2. Qualitative Findings

Participants' experiences of providing care to patients receiving ECT were categorised into four themes and 10 subthemes (Table 5).

TABLE 5.

Mental health nurses' experiences in providing care to patients receiving electroconvulsive therapy.

Category	Subcategories
Diversity in attitudes	Positive changes in perceptions of ECT
	Continuation of negative perceptions of ECT
	Concerns about the loss of dignity
Demand for knowledge and education	Lack of knowledge about ECT
	Need for professional education programmes
Increased work burden	Difficulties due to restrictions on drug use
	Poor cooperation in the process of preparing for ECT
	Various and widespread adverse effects
Responsibility for safety and stability	Alleviating patients' anxiety
	Preventing accidents

3.2.1. Diversity in Attitudes

3.2.1.1. Positive Changes in Perceptions of ECT

Before becoming MHNs, the participants had negative perceptions of ECT due to the negative language surrounding ECT and the notion of ECT being an inhumane and coercive treatment. However, after becoming MHNs, the participants observed that many patients received ECT safely and that the treatment had rapid therapeutic effects. They felt a sense of achievement from seeing their patients improve. This brought a positive change in participants' attitudes towards ECT to the extent that, if needed, they would recommend ECT to their family members.

When I was a student, I thought that artificially inducing convulsions in one's brain using ECT was a scary and last‐resort treatment. However, when I observed directly, I learned that ECT is used frequently, that many patients benefit from ECT, and that it is more than just a scary treatment with severe adverse effects. As a result, my views became more positive. [Participant 3]

3.2.1.2. Continuation of Negative Perceptions of ECT

Some participants continued to have the same (negative) perceptions of ECT that they held before becoming MHNs. The participants were particularly affected by cases in which ECT was completely ineffective, the symptoms relapsed within a short time, or the patient suffered severe adverse effects. Having negative attitudes towards ECT and doubts about its therapeutic effects created an internal conflict when nurses had to provide factual information, emotional support or hope to patients and they could not express their feelings honestly.

Patients feel anxious before they receive ECT. At these times, I wonder how honest I can be with them. This causes problems in building a relationship of trust with the patient. I have my own experiences and knowledge, but I am worried about how much of them I should reveal to the patient. I feel uncomfortable encouraging patients to receive ECT when I have negative feelings about ECT. [Participant 7]

3.2.1.3. Concerns About the Loss of Dignity

ECT is performed with the consent of the patient and their caregiver. Some participants had experienced patients who refused treatment after signing the consent form, but this was viewed as a psychiatric symptom, and the patient ultimately had to undergo ECT. However, other participants had doubts about whether it was correct to go against the patient's wishes and perform ECT, even if the refusal was the result of psychiatric symptoms. The latter group of participants expressed concerns about damaging the patients' dignity by providing the treatment under compulsion or coercion. They were also worried that patients' self‐esteem might be harmed due to decreased memory and self‐care ability as adverse effects of ECT.

I saw patients who were capable of self‐care. However, when the amnesia was too severe, they entered a state of regression, became completely incapable of self‐care, and appeared extremely confused. At times like those, I used to think that the patient might feel a loss of their dignity as a human being. [Participant 20]

3.2.2. Demand for Knowledge and Education

3.2.2.1. Lack of Knowledge About ECT

Considering the increasing use and importance of ECT in clinical practice, the participants felt that they had insufficient knowledge of ECT. They stated that they were curious about the mechanisms, effects and side effects of ECT. They were also curious about the differences between classic and modified ECT, but they were uncertain about the answers to these questions. When patients showed no therapeutic effects or showed severe adverse effects from ECT, the participants felt frustrated not knowing how this was related to the mechanisms of ECT and realised the insufficiency of their knowledge.

There was a patient who was very irritable and delirious, removed their IV, and could not take the 30 minutes of required rest when they returned to the ward after ECT. However, on some days, they are fine after ECT. I've heard that these changes and different responses are related to the duration of convulsions, but I feel both curious and frustrated that I don't know the exact reasons. [Participant 10]

3.2.2.2. Need for Professional Education Programmes

The participants reported receiving little education on providing care to ECT patients since their time as nursing students. Some hospitals provided irregular ECT education under the guidance of doctors. However, most hospitals depended on verbal explanations between nurses or required nurses to educate themselves. With the increasing use of ECT, the role of MHNs has become more important. They must provide patients and caregivers with thorough and accurate information and dispel preconceptions and misunderstandings about ECT. Therefore, the participants reported the need for systematic nursing education programmes on ECT. They also predicted that confirming the safety of ECT through direct observation would help provide accurate information and positive, experience‐based emotional support to patients.

While learning about ECT, I was shocked to learn that it can be used on pregnant women. I realised that it is actually a very safe procedure … I had the opportunity to directly observe the procedure during my psychiatric training, and I realised that the risks were not as huge as I had thought. Patients feel very anxious before ECT, but I feel that now I can give them some peace of mind. [Participant 4]

3.2.3. Increased Work Burden

3.2.3.1. Difficulties due to Restrictions on Drug Use

When patients receive ECT, the use of Benzodiazepines (or BDZ drugs) is restricted. Given that these drugs are typically used for anxiety, depression and suicidal ideation, the participants had to share the distress and worsened symptoms the patients experienced when they stopped taking the medication. It was also difficult for the participants to adopt measures in response to violent outbreaks due to the change in patients' condition after ECT, as they were unable to administer appropriate medications. Furthermore, the participants stated that even when they consulted with a doctor, they often could not receive help, being told that ECT was required and that there were no other treatments. This placed an increased burden on nurses, who had to deal with the patient's symptoms directly.

The hardest thing is taking patients off benzodiazepines for ECT, seeing them struggle with anxiety and insomnia, and asking for help. (By the time of ECT) The patients have been taking these medications for a long time. So, when they stop, their anxiety or suicidal ideation becomes very severe. In this situation, there aren't many drugs that can be prescribed, and even if there is an alternative, the effects are usually mild. It's difficult for me to watch, and it's difficult for the patient to withstand. Even if we ask the doctors for help, they say there's nothing they can do… I think handling that process is the hardest thing. [Participant 2]

3.2.3.2. Poor Cooperation in the Process of Preparing for ECT

A major nursing task is preparing for ECT. The participants stated that this task could not be performed smoothly if the patient was psychotic or had impaired cognitive function. Despite repeated explanations and frequent rounds, some patients did not follow fasting protocols or removed their IV route due to their psychiatric symptoms. Sometimes, the patients behaved as if they could not understand ECT. Some patients deliberately ate food to refuse ECT. When there are problems with pre‐ECT preparations, the treatment may be delayed or cancelled. Even if the patient receives ECT, there can be adverse effects, ultimately harming the patient. Therefore, the participants spent a lot of energy on making preparations for ECT.

Psychotic or cognitively impaired patients eat even after receiving NPO instructions. Even if we perform frequent rounds and watch them closely, it's difficult to stop them. No matter how much you explain or educate them, it's difficult when they can't understand because they have an impaired perception of reality. [Participant 3]

3.2.3.3. Various and Widespread Adverse Effects

The participants observed various adverse effects in patients due to ECT. Headache, sore throat, dizziness, myalgia and mild fever are common adverse effects that typically improve quickly. However, some patients suffer permanent dysuria or respiratory failure, and even though the patient's state of consciousness is checked before feeding, some patients face the risk of choking. As a common side effect of ECT, memory impairment can damage self‐care ability and lead to fatal accidents, especially among older adults if they lose their way. The participants experienced tension and embarrassment due to unexpected adverse effects. In addition, routine examination of patients after ECT currently does not include all severe adverse effects, which can lead to difficulties in coping.

I wished there were a clear tool available to systematically assess the patient's condition after ECT. Nurses get the patient to talk, and if they can, they start feeding. However, this situation is a bit vague and can be dangerous. I think it would help if there were some kind of tool to identify adverse effects and provide more concrete evidence. [Participant 21]

3.2.4. Responsibility for Safety and Stability

3.2.4.1. Alleviating Patients' Anxiety

The participants reported that dealing with patients' anxiety and fear of the ECT procedure and adverse effects was one of the most important aspects of ECT nursing. ECT causes patients more anxiety than other treatments because of the stigma associated with it. Thus, the participants remained next to the patients when they expressed their emotions related to ECT, listened closely and accepted their emotions. Some participants were able to approach patients in a more supportive manner and empathise with them based on their own fear of ECT.

ECT is performed by a doctor, but the nurse is responsible for pre‐ and post‐ECT care. In that process, I think that nurses provide patients with a lot of emotional support. Listening to and supporting the patient's emotions is a major part of it, and that role feels rewarding. [Participant 9]

3.2.4.2. Preventing Accidents

The participants stated that they made efforts to prevent accidents in ECT processes, such as the administration of general anaesthesia and electrical stimulation of the brain. The participants frequently identified mentality after ECT, taking care about the risk of falls and closely observed the patient for administering a rapid response to adverse effects. The participants considered pre‐ and post‐ECT care and ensuring that patients receive ECT in a safe environment as important aspects of nursing.

We perform several tasks to ensure that the patient receives ECT in a safe environment, such as administering the drugs required to prepare for ECT and taking action to prevent falls if the patient is not lucid after returning to the ward. I think safety management is a core nursing task that is performed in the ward. [Participant 13]

4. Discussion

The findings of this study showed that the attitude towards ECT differs among MHNs and there are certain ethical concerns. This is consistent with ECT being a controversial treatment (Gazdag and Ungvari 2019; Kring, Bergholt, and Midtgaard 2018; Sweetmore 2022) and with the findings of Ezeobele et al. (2022), which highlight an attitudes gap among MHNs regarding ECT. One factor that had a major role in creating a positive attitude towards ECT was whether ECT was effective for patients. This factor has also been reported by Lonergan, Timmins, and Donohue (2021). Participants who did not see therapeutic effects of ECT in their patients or those who had concerns about patients' dignity faced difficulties in providing emotional support to patients due to their negative attitude towards ECT. The concerns expressed by some participants about patients' dignity were mostly related to patients losing their self‐esteem and sense of autonomy. In fact, only 31.8% of the participants gave the correct response to the item ‘patients cannot be given ECT against their will’ on the QuAKE. This percentage is much lower than the percentage reported by Ezeobele et al. (2022) (94%), whose study was conducted in the United States. This result tends to indicate that patient autonomy is still not fully reflected in ECT administration in South Korea. As protectors of their patients, MHNs may experience internal conflicts when the provision of ECT is incongruous with their values and beliefs (Sweetmore 2022). This can be a major source of distress not only for MHNs, who have to alleviate patients' anxiety towards ECT through their therapeutic relationship, but also for patients, whose treatment choices are influenced by mental health professionals (Lonergan, Timmins, and Donohue 2021). Thus, in order to provide effective ECT nursing, it is essential to establish a suitable ethical basis for ECT (Sweetmore 2022). MHNs must reflect on their opinions and beliefs about ECT and how they affect therapeutic interactions.

The knowledge of ECT among the participants, with the level of 79% (mean score of 8.64 out of a total score of 11), was similar to the level reported by Ezeobele et al. (2022), which was 81%. However, through qualitative interviews, the participants reported insufficient knowledge of ECT and expressed the need for systematic education to fulfil their role of educating patients about ECT. In particular, they had insufficient knowledge about the mechanisms of ECT. Previous studies have also found that MHNs have inadequate knowledge about the ECT procedure (Sweetmore 2022). Another study found that MHNs had insufficient knowledge about ECT indications and mechanisms (Ezeobele et al. 2022). Although ECT is one of the most effective psychiatric treatments, aspects of its mechanisms remain unclear (Gazdag and Ungvari 2019; Grover et al. 2018). Therefore, it is necessary to gather more information about its mechanisms and use the information to improve MHNs' understanding of ECT. The participants obtained knowledge about ECT through irregular education from doctors, word of mouth among nurses, observations of ECT and personal exploration. Netshilema, Khamker, and Sokudela (2019) evaluated the knowledge of and attitude towards ECT among mental health professionals and found that they generally gather knowledge from doctor explanations. In this study, ECT was associated with various nursing problems, demonstrating the need for education that is more focused on nursing. To match the increasing use of ECT, there is a need for evidence‐based, systematic and professional education from the undergraduate level to clinical practice. Evidence‐based education improves nurses' ECT‐related knowledge and creates positive attitudes (Hayworth and Hyrkas 2020). Improved knowledge and positive attitudes can help MHNs educate ECT patients and their caregivers more effectively (Ezeobele et al. 2022).

MHNs assess patients' mental, legal and medical states as part of pre‐ECT care to ensure readiness for ECT, and they manage recovery from anaesthesia and address any post‐ECT side effects as part of post‐ECT care (Cleary and Horsfall 2014; Kavanagh and McLoughlin 2009). In our quantitative survey, nurses showed sufficient knowledge of pre‐ECT care, and qualitative interviews confirmed that nurses play a central role in preparing patients for ECT. However, this process was sometimes difficult. There are various indicators for ECT, such as life‐threatening symptoms due to severe depression, schizophrenia, suicidality or psychosis (Espinoza and Kellner 2022). Thus, aside from ECT consent, there could be cases where the patient was not involved in pre‐ECT preparations due to psychiatric symptoms or conditions. Benzodiazepines are stopped before ECT to avoid increasing the convulsive threshold (Jarosch‐von Schweder et al. 2011). However, this can exacerbate patients' anxiety, and it was usually the responsibility of MHNs' to sedate them without administering Benzodiazepines. These circumstances cause distress to both patients and MHNs, and there is a need for systematic support to allow assistance from other medical staff when necessary. During post‐ECT care, the participants observed various adverse effects. The main concern was cognitive dysfunction, but some participants observed more extensive and serious adverse effects. ECT rarely causes severe adverse effects such as cardiac arrhythmia, respiratory distress, prolonged apnoea, aspiration, prolonged paralysis and prolonged seizure (Espinoza and Kellner 2022). Appropriate identification and response capabilities may be lacking, and, as shown in our results, this can cause tension and anxiety among MHNs. Thus, there is a need for tools that enable comprehensive identification of ECT adverse effects, and protocols should be developed that include coping methods for different scenarios.

The participants considered ensuring the psychological, emotional and physical safety and stability of patients as their main role throughout the ECT process. Since patients experience anxiety and fear about the ECT procedure and the associated stigma, the MHNs considered providing psychological and emotional support to be especially important. Stigma still exists from the initial negative and shocking descriptions of ECT (Ezeobele et al. 2022). This makes it important to deal with patients' worries and fear concerning ECT (Cleary and Horsfall 2014). Thus, the empathic attitude exhibited by the participants is extremely important in providing care to patients receiving ECT. Through empathy, the patient can express their thoughts and problems honestly and undergo big therapeutic changes (Moudatsou et al. 2020). Owing to the use of anaesthetics, paralytic agents and sedative drugs and the severity of patients' symptoms, ECT is associated with a high risk of falls (Brown 2017). So, the risk of physical injury should also be heeded. In this regard, the participants made efforts to create a safe environment throughout the ECT process and prevent accidents stemming from ECT.

While the use of ECT is increasing, there has been a shortage of research on the experiences of MHNs, who perform a central role in ECT‐related care. This study is valuable because it explored the overall care experiences of MHNs. Our findings provide evidence to improve ECT‐related nursing practice, and this can ultimately improve the quality of patient care. However, since this study only included MHNs from some hospitals in South Korea, there are limitations in generalising their experiences. To gain more in‐depth understanding and insight, we propose that future research be conducted in multiple countries and settings.

5. Conclusion

The ECT‐related care experiences of MHNs encompass various dimensions, such as their perceptions and knowledge of ECT, their attitudes towards ECT and the actual nursing work involved in ECT. MHNs feel responsible for the safety and stability of patients receiving ECT and provide holistic care based on the patient's physical, psychological and emotional needs. For MHNs to provide high‐quality ECT care, it is essential to consider their perceptions of and attitudes towards ECT, provide suitable and sufficient education to them, develop protocols for different scenarios and encourage cooperative support from other medical teams.

6. Relevance for Clinical Practice

The findings of this study show that MHNs can facilitate shared decision‐making by openly sharing ECT effects with patients and caregivers and quelling misunderstanding, stigma and concerns based on their knowledge and attitudes towards ECT. By creating evidence‐based protocols for different scenarios and establishing cooperative systems with other healthcare units, it will be possible to provide more efficient and safer care. This approach will enable person‐centred care that reflects the physical, psychological and emotional needs of individual patients.

Author Contributions

Suyoun Ahn: conceptualisation, methodology, data collection and analysis, writing, editing. Soyoung Shin: conceptualisation, methodology, data collection and analysis, writing. Jaewon Joung: conceptualisation, methodology, data collection and analysis, writing, critical review, editing. All authors have read and agreed to the published version of the manuscript.

Ethics Statement

Ethical approval was received from the Institutional Review Board of the relevant ethics committee (IRB No. JBNU‐2023‐08‐013‐001). The participants were informed that they could withdraw from the study at any time without facing any penalties and that their data would remain confidential and be used solely for research purposes.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.