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A STUDY TO ASSESS THE KNOWLEDGE AND ATTITUDE OF FAMILY
MEMBERS OF MENTALLY ILL PERSONS WHO RECEIVE ELECTROCONVULSIVE THERAPY IN MENTAL HEALTH HOSPITAL.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
Mrs. FELICIA RETNA MEBEL
MENTAL HEALTH NURSING
Akshaya College of Nursing,
Tumkur, Karnataka.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1. Name of the Candidate
And address
: Mrs. FELICIA RETNA MEBEL
M.Sc Nursing, 1st Year
Akshaya College of Nursing,
Tumkur, Karnataka.
2. Name of the Institution
: Akshaya College of Nursing
3. Course of Study
And Subject
: M.Sc. Nursing 1st year,
MENTAL HEALTH NURSING
4. Date of Admission to
:
Course
5. Title of the Topic
:" A STUDY TO ASSESS THE KNOWLEDGE
AND ATTITUDE OF FAMILY MEMBERS
OF
MENTALLY
RECEIVE
THERAPY
HOSPITAL.
ILL
PERSONS
WHO
ELECTRO-CONVULSIVE
IN
MENTAL
HEALTH
6.1.NEED FOR THE STUDY
Electro convulsive therapy (ECT) is a safe and efficacious treatment; there is a
widespread negative view of electro convulsive therapy in public and professional
circles.
Decades of clinical experience and research have resulted in continued
improvements to the efficacy and safety of electro convulsive therapy.(Virit,Osman
2007)
Media portrayals of electro convulsive therapy (ECT) have misled the public.
Even some mental health professionals to view electro convulsive therapy with
suspicion and negativity. It is necessary to conduct research on this basis to modify
the misconceptions and prejudices about the electro convulsive therapy. Currently,
electro convulsive therapy is most commonly indicated for patients with severe
depression, especially those who do not respond to pharmacological treatment.
Electro convulsive therapy is also commonly used as an effective alternative to
medication for patients who have comorbid medical conditions. As such electro
convulsive therapy is three times more common in the elderly. It is also used for
depressed patients with psychotic symptoms or catatonia and for those at imminent
and severe risk for suicide.(Donald Fagerson 2008)
In addition to severe depression, electro convulsive therapy has been shown to
be efficacious in treating psychotic states and mania. Some evidence suggests that
electro convulsive therapy may accelerate treatment response to antipsychotic
medications for patients in acute phases of schizophrenia especially for those resistant
to medication.(Painuly,Chakrabathi 2006)
More research using randomized controlled studies is needed to examine
alternatives to traditional electro convulsive therapy.
These approaches such as
bifrontal electro convulsive therapy, asymmetric bilateral electro convulsive therapy
and focal electrically administered seizure therapy, may further minimize cognitive
effects and maximize efficacy. Several new biological treatment devices also hold
promise as a competitor to electro convulsive therapy, such as repetitive Tran cranial
Magnetic stimulation, deep brain stimulation, magnetic seizure therapy and trans
cranial direct current stimulation. Research, however has yet to demonstrate the
superiority of these devices to electro convulsive therapy atleast in short term
treatment of major depression (Erantin , Mcloughlin et al 2007).
Despite the wide consensus over the safety and efficacy of electroconvulsive
therapy, it still faces negative publicity and unfavourable attitudes of patients and
families. Little is known about how the experience with electro convulsive therapy
affects the patients and their families attitude toward it.Thus, there is an
overwhelming need to conduct an explorative study among to understand the family
members of patients knowledge and attitude toward electro convulsive therapy, such
a study would form a foundation over which other questions relating to the need for
health education and influence of attitudes toward electro convulsive therapy can be
formulated for future research. (Ramachandra 1997)
6.2.REVIEW OF LITERATURE
The review of literature is defined as broad.
Comprehensive in depth,
systematic and critical review of scholarly publications, unpublished scholarly print
materials, audiovisual materials and personnel communications.
It
helps in
identifying and searching for information a topic and developing an understanding of
the state of knowledge on that topic. (Basavanthappa B.T. 2003)
The literature review is arranged in the following categories.
1. Studies on knowledge and attitude of family members on electro convulsive
therapy.
2. Studies on knowledge and attitude of mentally ill persons on electro
convulsive therapy
1. Studies on knowledge and attitude of family members on electro convulsive
therapy.
Chavan et al (2006) conducted a study
on electro convulsive therapy:
knowledge and attitude among patients and their relatives..The main aim of this study
was to examine the knowledge and attitude of patients and their relatives towards
electro convulsive therapy.
Method used was a 16-item questionnaire with
satisfactory face validity and content validity was constructed and translated into
Hindi.
It was then administered to 89 patients and 83 relatives attending the
psychiatry services in a major hospital in North India.
More than 65% of the
respondents in both the groups, patients as well as relatives gave correct responses
such as electro convulsive therapy is life saving many times it causes temporary but
not permanent memory impairment and that electro convulsive therapy is not a nonscientific treatment. There was non-significant disagreement between the two groups.
They concluded that the study is a preliminary exploratory one and is likely to give
direction for further research with refined methodology.
Raj Kumar, Saravanan Jacob (2006), and conducted a study on the
perspectives of patients and relatives about electro convulsive therapy. This study
attempted to ascertain the news of patients and their relatives on the possible benefits
and adverse effects of electro convulsive therapy. The method used was qualitative
methodology using semi structured interviews, with the short Explanatory model
interview as the basis was used to interview 52 patients who received electro
convulsive therapy and their relatives before and after course of the treatment. The
most eloquent 10 among them were chosen for further in depth interviews.
Professional perception of efficacy and cognitive adverse effects were obtained from
the patients medical records. The result was more than half of the recipients were not
aware of the details of electro convulsive therapy even at the end of the course. But
they were not unhappy about receiving electro convulsive therapy. Most relatives
believed in the disease model, considered the illness serious, felt that enough
information about the treatment was provided, knew about its benefits and memory
problems and left that they were offered an alternative choice of treatment but also
admitted to perceiving coersion. All relatives had feared the consent for treatment
and most were not unhappy with electro convulsive therapy. There were significant
differences in perception between patients admitted to hospital involuntarily and of
these who agreed for admission.
Tang, unguart and chan (2002) examined the patients and their relatives
knowledge of experience with, attitude toward and satisfaction with electro
convulsive therapy in Hong Kong. The aims of this study were to examine patients
experience of electro convulsive therapy and patients and their relatives knowledge of
attitude toward and level of satisfaction with electro convulsive therapy. To this
effect a prospective cross-sectional survey was conducted involving 96 patients and
their 87 relatives. The study showed that the majority of patients believed they had
not received adequate information about electro convulsive therapy.
The most
commonly reported side effects was memory impairment. Patients and relatives had
only limited knowledge of electro convulsive therapy, yet the majorities of them were
satisfied with the treatment and having found it beneficial, maintained a positive
attitude toward its use. The researchers concluded that Hong Kong Chinese patients
and their relatives accepted electro convulsive therapy as a treatment. The way
information is provided to patients and relatives when obtaining consent for electro
convulsive therapy needs improvement.
Taieb and co-investigators (2001) conducted a study about electroconvulsive
therapy is adolescents with mood disorders: patients and parents attitudes. The aim of
the study was to cases retrospectively patients and parents experiences and attitudes
towards the use of electro convulsive therapy adolescence.
The experiences of
subjects (n = 10) who were administered electro convulsive therapy in adolescence
for a severe mood disorders and their parents (n=18) were assessed using a semistructured interview after a mean of 4.5 years (range 19m – 9yrs). Their attitudes
were mostly positive and electro convulsive therapy was considered a helpful
treatment. Concerns were frequently expressed, probably because electro convulsive
therapy was not fully understood by the patients and their families. Most complaints
were of transitory memory impairment. The parents were satisfied with the consent
procedure, while all but one patient did not remember the consent procedure. They
concluded that, despite negative views about electro convulsive therapy in public
opinion adolescent recipients and their parents shared over all positive attitudes
towards the use of electro convulsive therapy in this age range.
Garry, Karryn, and Joseph (1999) conducted a study to obtain views on the
treatment among parents of adolescents who received electro convulsive therapy.
The study assessed the experience, knowledge and attitudes of parents of adolescents
who had been treated with electro convulsive therapy about the treatment. A 56-item
survey was constructed by the researchers to asses the views about electro convulsive
therapy of parents of persons who received this treatment before age 19. People
under age 19 who received electro convulsive therapy in the Australian state of new
south wales between September 1990 and 1998, were identified through inspection of
hospital electro convulsive therapy registers. Twenty-eight parents were interviewed
after obtaining informed consent, overall, their opinion about electro convulsive
therapy was favourable seventeen of 28 parents thought that electro convulsive
therapy had been helpful. If electro convulsive therapy was recommended by a
doctor, the majority of parents would support a decision for their child to have the
treatment again and would advice others to consider it. Almost two-thirds of parents
or 17 respondents, believed that electro convulsive therapy had been beneficial.
About a third, or nine respondents, thought electro convulsive therapy had made
difference to the patients clinical state. One of the parents believed that treatment had
made the child worse.
Shows data on parents opinions about the side effects
associated with their child’s electro convulsive therapy and with psychotrophic
medication reported that no statistically significant differences were found between
electro convulsive therapy and medication in the perceived frequency of specific side
effects except that parents were more likely to report children’s headaches with
electro convulsive therapy than with medication.
Szuba et al (1991) in correlated study conducted to assess the patient and
family perspectives of electro convulsive therapy. Study surveyed 25 patients who
were prescribed electro convulsive therapy and a relative of each patient for their
attitudes, knowledge and opinions about electro convulsive therapy and then
resurveyed them after the treatment.
Patients were rated with the Hamilton
Depression Rating scale and Young Mania Rating Scale based on diagnosis before
and after electroconvulsive therapy. Patients and family members and highly positive
attitudes toward electro convulsive therapy. They felt the electro convulsive therapy
was beneficial.
2.Studies on knowledge and attitude of mentally ill persons on electro convulsive
therapy
Mehreen Arshad et al (2007) assessed the awareness and eruptions of electro
convulsive therapy among psychiatric patients: a cross – sectional survey from
teaching hospitals in Karachi, Pakistan. The researches founds electro convulsive
therapy is shown to be effective in many psychiatric illness, but its distorted
projection by the Pakistani media and its unregulated use by many physicians across
the country have adversely affected its acceptability. Given this situation they aimed
to assess the awareness and projections regarding electro convulsive therapy as a
treatment modality among the psychiatric patients. They interviewed 190 patients of
which 140 were aware of electro convulsive therapy. The study showed that the level
of education had a significant impact on the awareness of electro convulsive therapy
(p = 0.001). The most common source of awareness was electronic and print media
38%, followed by relatives 24% and doctors 23%, physical injuries 42% and
neurological 12% and cognitive disturbance 11% were the commonly feared side
effects. The most popular belief about electro convulsive therapy was that it was a
treatment of last report (56%). Thirty nine percent thought that electro convulsive
therapy could lead to severe mental and physical illness and 97% considered it
inhumane. Patients willingness to receive electro convulsive therapy was dependent
on whether or not they were convinced of its safety (p = 0.001) and efficacy (p =
0.0001). In conclusion they identified a serious lack of dissemination of information
regarding electro convulsive therapy by the psychiatrists and the mental health care
providers.
Diana et al (2005) studied about the information consent and perceived
coercion: patients perspectives on electro convulsive therapy, 17 reports dealts with
patients views on information and consent in elation to electro convulsive therapy,
134 testimonies or first hand accounts were identified. The reports were subjected to
a descriptive systematic view. The testimony data were analyzed qualitatively.
Approximately half the patients reported that they had received sufficient information
about electro convulsive therapy, and side effects. Approximately a third did not feel
they had freely consented to electro convulsive therapy even when they had signed a
consent form.
Sienaert et al (2005) studied on patient satisfaction after electroconvulsive
therapy. The main objective of the study was to determine the degree of satisfaction
with bifrontal and right unilateral electro convulsive therapy and to investigate the
relation with treatment related variables, such as memory ,complaints and patients
related variables such as self – related depression severity and negative affectivity.
The method used way all patients who started a course of electro convulsive therapy
or still were receiving continuation or maintenance electro convulsive therapy, (C/M
– electro convulsive therapy) at the time of study. A psychiatric nurse who was not a
member of the treatment team conducted semi-structured interviews based on a
battery of questionnaire (Patient satisfaction survey) (PSS), Mini-mental state
Examination (MMSE).
Squire subjective memory questionnaire (SSMK), Back
depression inventory (BDI) and Positive and negative affect schedule (PANAS). The
result obtained of 50 eligible subjects, 36 (72%) completed the survey, Bifrontal
electrode position was used in 25 (69.4%) of the study patients and unilateral is 4
(11.1%).
Patient had a considerable degree of satisfaction, although they had
prominent cognitive complaints.
Ori et al (2005) conducted a study about the dimensions of power: older
women’s experiences with electro convulsive therapy.
This qualitative study
explored the experiences of 6 older women who were treated with electro convulsive
therapy for a diagnosis of depression, using in-depth personal interview. Analyses
suggest that this experience for these older women could not be understood in
isolation. Rather, their stories highlighted the importance of interpreting the electro
convulsive therapy experience with a broader context that included the larger
depression experience, the dynamics of helping relationships and the discourse
available to them for sense – making.
Brodatty et al (2004) assessed the perceptions of outcome from electro
convulsive therapy by depressed patients and psychiatrists 81 patients with major
depression were assessed before and after receiving a course of electro convulsive
therapy. On both occasions, patients were administered the Hamilton Rating scale for
depression and Global assessment of functioning scale. Patients and two research
psychiatrist rated their expectancy of treatment outcome before electro convulsive
therapy and their impression of outcome after electro convulsive therapy was
completed. Before treatment 39.7% of patients believed electro convulsive therapy
would improve their condition, following treatment 08.8% of patients thought their
condition had improved as a result of electro convulsive therapy.
Koopowitz et al (2003) studied on the subjective experience of patients who
received electro convulsive therapy. Using an exploratory descriptive methodology
this study aim to provide an insight into what certain patients actually think of electro
convulsive therapy. The method used was semi structured interviews were conducted
to explore the patients opinions and experiences of electro convulsive therapy.
Interviews were subjected to analyse by five step framework approach that identified
prominent themes in relation to 5 broad questions and in conjunction with issues
raised by subjects themselves.
The four themes are fear of electro convulsive
therapy, attribution of cognitive ,affective and memory loss to electro convulsive
therapy, positive electro convulsive therapy experiences and patients suggestions.
They concluded that using such a qualitative approach the depth of information
obtained has revealed new perspectives on how patients perceive the experience of
electro convulsive therapy.
Walter et al (1999) investigated on electro convulsive therapy in adolescents:
experience, knowledge and attitude of recipients. The patients were interviewed and
the experiences and opinions about electro convulsive therapy were generally
positive. 50% stated electro convulsive therapy had been helpful, approximately
three quarters believed their illness was worse than the either electro convulsive
therapy or pharmacotherapy. A slight majority had attempted to conceal the history
of electro convulsive therapy treatment.
The vast majority considered electro
convulsive therapy a legistimate treatment and if medically indicated would have
electro convulsive therapy again and would recommend it to others.
Jesse et al (1998),conducted a study on patient satisfaction with electro
convulsive therapy. The main objective was to determine whether patients who had
electro convulsive therapy are satisfied with their treatment and demonstrate more
favourable attitudes about electro convulsive therapy compared with controls. They
developed a 44 item survey measuring electro convulsive therapy treatment
satisfaction and attitudes. The survey was administered to 24 patients near the end of
electro convulsive therapy treatment and 2 weeks later. A modified survey was
administered to 24 out patient controls who had never received electro convulsive
therapy and who were recruited from a psychiatric clinic waiting room. The result
was patients who received electro convulsive therapy had positive attitudes about it.
Attitude score was significantly higher for the electro convulsive therapy group
compared with controls.
They concluded that patients who received electro
convulsive therapy were satisfied with their treatment and had more favourable
attitudes about it than patients who did not receive this treatment.
Pettinati et al (1994) conducted a study on patients attitude toward electro
convulsive therapy. This study surveyed attitudes toward electro convulsive therapy
in 78 depressed inpatients, twice during hospitalization and at 6 months after
discharge, using a semi – structured interview. Significantly 56 electro convulsive
therapy – treated patients were favourable about electro convulsive therapy,
compared to 22 depressed patients never treated with electro convulsive therapy, both
at pretreatment (chi square = 8.4, df=1, p<0.001) and at post treatment (chi square =
12.5, df = 1, p< 0.01). Favourable attitudes were maintained after 6 months.
Ramachandra 1990, conducted a study of psychiatric patients knowledge
attitude and experience about electroconvulsive therapy, Department of nursing,
NIMHANS, Bangalore purposive sampling technique was used for obtaining samples
of 50 for this study. Interview schedule was used to assess patients after 48 hours
before one week of the termination of the course of electroconvulsive therapy.
Univariate statistics and ANOVA was used to compare groups among independent
variables it was found that the occupation of the patient did not influences their
knowledge towards electroconvulsive therapy is was also found that it did influences
their attitude and experience. Psychiatric patients coming from rural area has positive
attitude towards electroconvulsive therapy.However it did not influence the
knowledge and experience clinical variable like the number of electroconvulsive
therapy and the diagnosis were not significantly associated with the level of
knowledge attitude and experience of psychiatric patients towardselectroconvulsive
therapy. The findings of the above study contradicted the view of investigators and
helped to formulate the hypothesis as number of electroconvulsive therapy increase
the cumulative effects of patients on cognitive functions.
6.3STATEMENT OF THE PROBLEM
A study to assess the knowledge and attitude of family members of mentally
ill persons who receive Electro-convulsive therapy in mental health hospital.
6.4OBJECTIVES OF THE STUDY
1. To assess the knowledge of family members of mentally ill persons who
receive electro convulsive therapy.
2. To assess the attitude of family members of mentally ill persons who receive
electroconvulsive therapy.
3. To correlate the knowledge and attitude of family members of mentally ill
persons who receive electroconvulsive therapy .
4. To associate knowledge of family members of mentally ill persons who
receive electroconvulsive therapy with selected demographic variables.
5. To associate attitude of family members of mentally ill persons who receive
electroconvulsive therapy with selected demographic variables.
6.5OPERATIONAL DEFINITIONS
1. Knowledge
A familiarity gained by experience, learning and understanding regarding the
nature and uses about electroconvulsive therapy after undergoing treatment course.
2. Attitude
The family members like and dislikes towards the electro convulsive therapy
given to mentally ill client.
3. Electro convulsive therapy
Electro convulsive therapy is the artificial induction of a grandmal seizure
through a application of electrical current to the brain.
4. Family members of mentally ill persons
Individuals who are relatives with the persons and take care of persons those
who are mentally ill. .
5.Mental health hospital
Centre which ensure availability and accessibility of minimum mental health
care for all.
6.6.HYPOTHESIS
1. There will be a significant association between the knowledge of family
members of mentally ill persons who receive electro convulsive therapy and
selected demographic variables.
2. There will be a significant association between the attitude of family members
of mentally ill persons who receives electro convulsive therapy and selected
demographic variables.
7. MATERIALS AND METHODS
7.1.SOURCES OF DATA
Research approach
:A Descriptive Survey
Research design
: A non experimental,
Descriptive Survey
Setting of study
: The study will be conducted in
Selected mental health centre
Sample size
: 50 family members
Sampling technique
: Convenience sampling
Selected variables
: Demographic variables
Sample criteria
Inclusion criteria
 Family members of electro convulsive therapy who
received
mentally ill persons
 Family members; male or female of 18 – 75 years of age
 Family members of those who are getting treatment in mental
health centre,
Exclusion criteria:
 Friends and cousins are not involved in the criteria
 Family members who are not willing to participate
 Family members who are not able to understand Kannada
7.2 METHODS OF DATA COLLECTION
After obtaining the permission from the school authorities, the investigator
will introduce himself to the school children and the data will be collected from them.
Tool for data collection
: structured interview questionnaire on the
family member of mentally ill persons who
receive electro convective therapy
Part-A
: Proforma for collecting the demographic data
Part-B
:
Structured
questionnaire
to
assess
the
knowledge and attitude on the family member
of mentally ill persons who receive electro
convective therapy
Methods of data analysis and interpretation
Data will be analyzed according to the objectives of the study using
descriptive and inferential statistics and will be presented in the form of tables, graphs
and diagrams.
Duration of the study
: 6 weeks
7.3 Does the study require any investigation or interventions to be conducted on
the patients or other human being or animals? If so please describe briefly
No
7.4 Has ethical Clearance been obtained from your institution?
Yes
Bibliography
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Basavanthappa, B.T. (2007). Nursing theories (1st edn.). New Delhi;
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Bhatia M.S. (2004). Essentials of psychiatry, New Delhi: CBS Publishers,
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Gail, W; stuart; Michale,; Laraia. (2005). Principles and practice of
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Gelder, Gath, Mayou, Cowen (1996) Oxford Text book of psychiatry New
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Jacobson L, Jacobson M, (1996). Psychiatric secrets, New Delhi: Jaypee
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6. Taieb O. Flamat MF. Corcos M. et al (2001). Electro convulsive therapy
in adolescents with mood disorder: patients and parents attitudes
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(http://www.ect.org)
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(http://www.ectjournal.com) 23 (2): 82 – 88.
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knowledge and attitudes toward ECT, (http://www.ect.org) 21(4): 255.
11. Osman (2007). Patients and their relatives attitudes toward electro
convulsive therapy in Bipolar disorder (http://www.ectjournal.com)
12. Campos CJ. Higa CM. Patients and relatives opinion and knowledge about
ECT: Implications for nursing.Journal of ECT.1997; 31 (2): 191 – 205.
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(1): 34 – 38.
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Information, consent and perceived coercion: Patients perspectives on
ECT. The British journal of psychiatry. 2005: 186: 54-59
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16. Jesse A. Goodman. Loss EV. Glenn ES. Teresa AR. Thomas P. Patient
satisfaction with ECT. The journal of ECT. 1998:14 (2):136.
9.
Signature of student
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10.
Remarks of the Guide
:
11.
NAME & DESIGNATION OF
:
11.1 Guide
:
11.2 Signature
:
11.3 Co-Guide (if any)
:
11.4 Signature
11.5 Head of Department
:
:
11.6 Signature
:
12. 12.1 Remarks of the Principal :
12.2 Signature
: