INTRODUCTION:

Electroconvulsive therapy (ECT), also known as electroshock, is a psychiatric treatment in which seizure are induced by passing electricity through the brain of an anesthetized patient ECT was introduced as a treatment for schizophrenia in the 1930s, and then become treatment for a wide range of psychiatric disorders.

Electroconvulsive therapy (ECT) has been a safe and effective treatment option for many years now for major psychiatric disorders, including major depression, bipolar affective disorder, and schizophrenia. Today, ECT has evolved into a modern procedure with a benign side effect profile, which is performed under anesthesia and the administration of muscle relaxants. Despite this, negative view of ECT is held not only by the general lay public but also by the medical professionals including nurses. Good amount of research from both developed and developing countries has assessed the knowledge about ECT among patients and their relatives, and evidence is suggestive of patients receiving ECT being poorly informed about it. In contrast to studies on knowledge and attitude toward ECT in patients and their relatives, the data pertaining to different health-care professionals including medical students, nurses and nursing students, physicians, psychologists, and social workers from developing countries are very limited.

Nursing students are going to be future nurses, and owing to the close involvement of nurses with the patients both pre- and post-ECT, the knowledge on ECT of nurses who work in ECT room can have direct impact not only on their quality of nursing practice but also on the patients' and their relatives' knowledge about ECT. There are studies which suggest that nurses and nursing students have a significant poor knowledge about ECT when compared to medical students. Negative attitude of nurses toward ECT is likely to be reflected negatively in their practice as well. Research suggests that nurses who have poor knowledge about ECT express boredom, apathy, and hostility toward patients who undergo ECT. Further, research also suggests that educating them with brief lectures, educational videotapes, familiarizing with the equipment used for ECT, and observing the ECT procedure can improve the poor knowledge. To understand the baseline knowledge of ECT among nurses and to plan modes to address their poor knowledge and negative attitude, the best suited group to assess would be nursing students who have not witnessed ECT treatment in patients and who have not been to psychiatry rotation before. For this, we aimed to assess the knowledge about ECT in nursing students.³

BACKGROUND OF STUDY:

Electroconvulsive therapy (ECT) involves the induction of a grand mal seizure through the passage of an electrical current to the patient brain with the aim of improving the patient mental status under anesthesia and muscle relaxant. There is no solid based clarification for the mechanism of action and how the ECT works but the most credibility goes to the biochemical theory. ECT was first introduced into psychiatry more than seven decades back 1938 in Rome by an Italian neuropathologist and psychiatrist Ugo Cerletti ECT is widely prescribed worldwide and first indicated in the emergency treatment of severe depression with suicide or psychosis medication-resistant schizophrenia" Effectiveness of ECT in the treatment of depression was established in 1941. The introduction of psychopharmacology in the 1970s and 1980 reduced the use of ECT in the treatment of mental illnesses Modified and non-modified ECT are the two forms of the treatment, modification comes in the form of sing anesthesia together with muscle relaxant in limit the intensity of coin and reduce its side effects as bone and teeth fractures, muscular and tendon damage Most of the internationally established guidelines recommended the modified ECT in the last decade as the slandered routine treatment “Unilateral treatment is prescribed for some patient instead of bilateral treatment to overcome the most frequently occurring side effects as temporary memory loss, mental confusion and headache, while permanent cognitive impairment.⁴

Today's nursing students are tomorrow's nurses who will be closely working and taking care of the patients. The nature of nursing profession requires nurses to spend more hours with the patients than all other health care professionals and considering the valuable and essential musing interventions provided to the patients undergoing ECT prior, during and after the treatment session, therefore, manses' knowledge and attitudes towards ECT will impact their patients knowledge and attitudes towards ECT Literature review reveals several studies exploring nurses knowledge and attitudes towards PET It has been suggested that there is a positive relationship between years of clinical experience and knowledge of mental health professionals regarding ECT and their attitudes towards ECT, while poor contact with ECT during students training was connected to poor knowledge and more negative attitudes.⁶

Because of the dramatic increase of the nursing student enrolled in any nursing schools and the inadequate patients' number undergoing ECT that limit every student chance to attend a live ECT treatment session, alternative educational materials have been introduced to inform students about ECT as lectures, pamphlets and real and simulated video scenes. However, the literature a paucity of published studies concerning knowledge and attitudes towards ECT on the Saudi Arabian national level.

The aim of the present study was to explore the effect of educational experiences on the knowledge and attitudes towards ECT among nursing students.

NEED FOR THE STUDY:

Man is in search of knowledge since time immemorial. Knowledge is all that information. While gathering knowledge about particular thing, he develops attitude towards it simultaneously. Some scholars and researcher attempted to explore white and tide towards electroconvulsive therapy.

Electro convulsive therapy (CT) 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.

Electroconvulsive therapy is one of the commonly used treatment modalities for patients with severe mental disorders. However, acceptance of ECT by the patient and relatives often depends on how the health-care professionals themselves present the treatment modality to the patients and their relatives. There is a lack of information about the knowledge on ECT among health professionals. The objectives were to evaluate the knowledge about and attitude toward ECT among nursing students. Methodology Knowledge of and attitudes toward ECT among nursing students were assessed using ECT knowledge questionnaires. The Results showed that, the study included 183 nursing students. Majority (n = 62; 60.8%) of the participants obtained information about ECT from media (movies, television, print media, etc.). None of the students had full knowledge about ECT. Although a significant proportion of students had knowledge about the ECT procedure and consent procedure, majority of them had poor knowledge about the effectiveness, mechanism of action, indications, and side effects of ECT. Negative attitudes were also highly prevalent, with more than two-thirds of the participants having negative attitudes toward ECT on more than half of the attitude items of the scale. Total knowledge score positively correlated with total attitude score, suggesting that higher knowledge was associated with more positive attitude. Conclusions Although nursing students have knowledge about basic ECT procedure and consent, they lack knowledge about the effectiveness, mechanism of action, indications, and side effects of ECT. Negative attitude toward ECT is also highly prevalent among nursing students. Accordingly, there is a need to improve the knowledge of nursing students, which may ultimately lead to better acceptance of the treatment.⁸

A study was conducted at Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, USA. This study examined the stability of patients' attitudes toward electroconvulsive therapy. The survey responses were highly significantly correlated and not significantly different, which suggests that attitudes toward ICT are stable during this time Electro convulsive therapy was first described by Cerletti & Bini in 1938 as treatment for schizophrenia. Electroconvulsive therapy demonstrated that it is much more effective as a treatment for affective disturbance.

Nursing students play an essential role in ECT, because of their close involvement with patient before and after the procedure. The knowledge of the nursing students working in ECT room can have direct impact on the quality of their nursing practice so, there is a need to improve the knowledge regarding ECT among nursing students.

PROBLEM STATEMENT:

A study to assess the effectiveness of planned teaching programme on knowledge regarding electroconvulsive therapy among third year basic B. Sc nursing students in selected nursing college.

OBJECTIVES OF THE STUDY:

· To assess the level of knowledge regarding Electroconvulsive therapy among third year Basic B.Sc. nursing students

· To assess the effectiveness of planned teaching on level of knowledge regarding Electroconvulsive therapy among third year Basic B.Sc. nursing students.

· To determine the association between the level of knowledge regarding Electroconvulsive therapy among third year Basic BSc nursing students with their selected demographic variables.

SCOPE OF THE STUDY:

The study will help the students to know details knowledge about electroconvulsive therapy.

HYPOTHESIS:

H₀: There will be no significant difference between the pre-test and post-test knowledge regarding electroconvulsive therapy among third year Basic B.Sc. nursing students measured at p<0.05 level of significance.

H₁: There will be significant difference between the pre-test and post-test knowledge regarding electroconvulsive therapy among third year Basic B.Sc. nursing students measured at pe0.05 level of significance.

REVIEW OF LITERATURE:

Written literature reviews are the critical summaries of what is known about a particular topic. The review serves as an integrative function and facilitates the accumulation of knowledge. Hence, review of literature is important to a research in order to know what has been established and documented. Review of literature is important for having a broad understanding of problem. The material gathered in the literature review should be treated as an integral part of research data. Since what is found in the literature can not only have an influence which is important in the formalities of the problem and the design of research, but also provides useful comparative material when the data collected in the research is analyzed.

The literature review is presented in this chapter under the following headings:

· Reviews of literature related to electroconvulsive therapy.

· Reviews of literature related to effectiveness of planned teaching on knowledge regarding electroconvulsive therapy.

A cross-sectional study was conducted on knowledge about and attitude toward ECT in nursing students. The objective was the study to assess the knowledge about and attitude toward ECT in nursing students. in which knowledge about ECT and attitude toward this treatment was assessed in nursing students using ECT knowledge and attitude questionnaires. Statistical analysis was carried out using the Statistical Package for the Social Sciences. A total sample consist of 54 3^rd-year nursing students was included in the study. More than half (59.3%) reported the primary source of information as media. None of our students had full knowledge about ECT, i.e., score of 31. The mean knowledge score was 16.22 ± 3.36, with a range of 10–21. They were more knowledgeable about the consent, side effects, and procedure part of the questionnaire compared to indications and effectiveness parts of it. Negative attitude toward ECT was highly prevalent. The mean score on attitude questionnaire was −7.5 ± 3.61, with a range of 0 to −12. More than three-quarters of our students had negative attitude in 12 out of 16 items. Total score on knowledge questionnaire and total score on attitude questionnaire were correlated positively (r_s= 0.442, P < 0.001). There is a deficiency in knowledge and highly prevalent negative attitude toward ECT among nursing students which needs to be rectified so that ECT becomes a more acceptable treatment procedure.

A study was conducted on effectiveness of structured teaching program on knowledge regarding ECT among nursing students in college of nursing, CMC Hospital, Ludhiana, Punjab. A quasi experimental two group pretest and posttest design was considered to be appropriate, purposive sampling technique was used by inclusion/ exclusion criteria. The sample size was 60 students of GNM III Year. The study concluded, in experimental group majority of nursing students had below average knowledge in pretest and had excellent knowledge regarding ECT in posttest.

A study was conducted on knowledge about and attitude towards Electroconvulsive Therapy among nursing students. The questionnaire method is used to assess the knowledge of and attitudes towards ECT among nursing students. The sample size Was 183 students. Majority (60.8%) of the participants obtained information about ECT from media. None of the students had full knowledge about ECT. Although nursing students have Knowledge about basic ECT procedure and consent. The study concluded that the students have lack of knowledge about the effectiveness, mechanism of action, indication, and side effects of ECT. Negative attitude towards ECT is also highly prevalent among nursing students.

A study was conducted on ECT; effect of an educational experience on nursing students knowledge and attitudes. A quasi experimental research design was used to conduct the study. The Sample size was 97 female nursing students. As a result no. statistically significant differences in the mean knowledge or attitude scores between students who have past experience and who do not have past experience with a person with diagnosis of mental health problem. The study concluded positive educational experience would increase the knowledge of ECT, which might in turn contribute to more favorable attitudes towards ECT. Proper educational materials and mass media programs aiming to increase students and practitioners’ awareness about ECT are recommended.

RESEARCH METHODOLOGY:

Figure No. 1: Schematic Presentation of Research Methodology Criteria for Sampling Selection

Inclusion Criteria:

1. Third year basic B.SC nursing students in selected nursing college.

2. Third year basic B.SC nursing students who are willing to participate in the study.

3. Student who knows English.

Exclusion Criteria:

1. Students who are not studying in third year basic B.SC nursing class.

2. Students who are not willing to participate

3. Student who doesn’t know English.

Table no. 1: Scoring procedure on knowledge regarding electroconvulsive therapy.

Sr. No.	Level of knowledge score	`Score range	Percentage range (%)
1.	Poor	1 – 10	0 < 50%
2.	Average	11 -20	51 % - 75 %
3.	Good	21 – 30	76 % - 100 %

Analysis and Interpretation Organization of Findings

The analysis and interpretation of the observations are given in the following sections:

Section I: Distribution of third year B. Sc nursing students in the selected nursing college with regards to demographic variables.

Section II: Assessment of level of knowledge regarding electroconvulsive therapy among third year B. Sc nursing students.

Section III: Evaluation of the effectiveness of planned teaching on knowledge regarding electroconvulsive therapy among third year B. Sc nursing students

Section IV:

Association between the level of knowledge score with their selected demographic variables.

Section: I Distribution of Sample with Regards to Demographic Data:

Table 2: Percentage wise distribution According to demographic characteristics (N = 50)

Sr N.	Demographical Variables	Categories	Frequency	(%)
1.	Age(years)	19	0	0%
		20-21	12	40%
		21-22	16	53.33%
		Above 22	2	6.67%
2.	Gender	Male	11	36.67%
2.	Gender	Female	19	63.33%
3.	Source of knowledge	Mass media	25	83.34%
		Family and friends	0	0
		Workshop/ conference/ seminar	1	3.33%
		Book and journal	4	13.33%

Background Variable:

Table No. 2 Distribution of sample based on background variables.

Characteristics	Frequency	Percentage %
1. Do you have any medical professional in your family?
Yes	10	33.33%
No	20	66.67%
Characteristics	Frequency	Percentage %
2. Previous knowledge regarding electroconvulsive therapy?
Yes	12	40%
No	18	60%

Assessment on level of Knowledge Regarding Electroconvulsive Therapy Among Third Year B. Sc Nursing Students:

Table no. 3: Frequency and percentage distribution on level of knowledge electroconvulsive therapy among third year B. Sc nursing students N = 30

Level of knowledge score	Pre-test score		Post-test score
Level of knowledge score	Frequency	(%)	Frequency	(%)
Poor (1- 10)	15	50%	0	0%
Average (11-20)	15	50%	6	20%
Good (21-30)	0	0%	24	80%

Evaluation of the Effectiveness of Planned Teaching About Knowledge Regarding Electroconvulsive Theapy Among Third Year B. Sc Nursing Students in a selected Nursing College.

Above table shows that, the mean pretest score was 10.9 with the standard deviation 3.68, whereas in post test the mean score was 17.7 with the standard deviation of 5.98. The findings show that the calculated ‘t’ value was 4.29 for knowledge regarding electroconvulsive therapy. The calculated‘t’ value was much higher than the tabulated value at of at df 29. This data signifies that the planned teaching was effective in assessing the knowledge of electroconvulsive therapy among third year B.Sc nursing students in selected nursing college. Hence, it was strongly interpreted that the planned teaching regarding study electroconvulsive therapy was effective. So the H₁ is accepted.

Table no 4: Mean, standard deviation, mean differences in scores and ‘t’ value for regarding electroconvulsive therapy among third year B. Sc nursing students in selected nursing college. N=50

Sr. no.	Knowledge level	Mean	SD	t value	Significance
1.	Pre test	10.9	3.68	4.29	P<0.05
2.	Post test	17.7	5.98	4.29	P<0.05

P<0.05level *significant

Table no. 5: Frequency, percentage and Chi square (χ2) analysis on level of knowledge among third year B. Sc nursing students with their selected demographic variables N==30

Sr. no.	Demographical variables	Level of knowledge						Chi square
Sr. no.	Demographical variables	Poor		Satisfactory		Good		(χ2)
1.	Age	Frequency	%	Frequency	%	Frequency	%
	19 year	0	0%	1	3.33%	3	10%	χ2= 0.61^NS
	20-21	0	0%	4	13.33%	13	43.34%	df=6
	21-22	0	0%	1	3.33%	8	26.67%
	Above 22	0	0%	0	0%	0	0%
2	Gender							χ2= 3.75^NS
	Male	0	0%	4	13.33%	6	20%	df=2
	Female	0	0%	2	6.67%	18	60%
3	Source of previous knowledge							χ2= 1.59^NS
	Mass media	0	0%	6	20%	19	63.34%	df=6
	Family and	0	0%	0	0%	0	0%
	Friends	0	0%	0	0%	0	0%
	Workshop/ conference/	0	0%	0	0%	1	3.33%
	Seminar	0	0%	0	0%	1	3.33%
	Books and	0	0%	0	0%	4	13.33%
	Journals	0	0%	0	0%	4	13.33%
4	Do you have any medical professional in your family?							χ2= 1.25^NS
	Yes	3	0%	2	6.67%	5	13.33%	df = 2
	NONN No	3	0%	7	13.33%	10	66.67%
5	Previous knowledge regarding electroconvulsive therapy?
	Yes	3	0%	3	6.67%	6	13.33%	χ2=0.7^NS
	No	3	0%	6	13.33%	9	66.67%	df = 2

*significant

NS- non significant

df= degree of freedom

Association of Knowledge Score with Their Demographic Variables:

Distribution of subjects according to the demographic variables shows that, out of the 30 subjects, Reveals that the association between selected demographic variables and posttest knowledge score.

The obtain chi – square value regarding age: 0.61(P<0.05), regarding gender: 3.75(P<0.05), regarding source of previous knowledge: 1.25(P<0.05) were not significant. The obtain chi – square value regarding the fact, whether students had any medical professional in your family: 1.25(P<0.05), regarding the fact whether students have any previous knowledge on electroconvulsive therapy: 0.7(P<0.05) were not significant.

Thus, the null hypothesis H₀: There is no significant difference between the pre test and post test knowledge regarding electroconvulsive therapy among third year B. Sc nursing students measured at p<0.05 level of significance is rejected and the research hypothesis, H₁: There is significant difference between the pre test and post test knowledge regarding electroconvulsive therapy among third year B. Sc nursing students measured at p<0.05 level of significance is accepted.

There was no significant association between level of knowledge with their demographic variables such as age, gender, source of previous knowledge and background of variable in this study.

SUMMARY:

The researcher has selected this study keeping in mind the necessity to improve the knowledge regarding electroconvulsive therapy among third year B. Sc nursing students in selected nursing college.

Major Findings of The Study:

The following were the major findings of the study

Section I:

Demographic Variables:

Demographic s for the present study show, out of the 30 subjects, Reveals the background factor of electroconvulsive therapy among Basic B.Sc. nursing students like age, gender, source of previous knowledge regarding age majority of the sample 16(53.33%) belong to the age group of 21-22 year and least 2 (6.67 %) belong to the age group of 20-21 and above. Regarding sex majority of the sample 19(67.33%) are female and least 10(36.67%) are male. Regarding the source of knowledge majority of the sample 25(83.34 %) of mass media and least 1(3.33%) of workshop/conference/seminar. It is inferred that the majority of the students had 21-22 years of age. Females are slightly more than males. The majority of sample had mass media source.

Reveals that majority of students 20 (66.67%) of the sample had no any medical professional in family. Table show that most 24 (80%) of the sample had not any previous knowledge on electroconvulsive therapy. It is inferred that the majority of students did not have medical professional in family. Majority of students did not have previous knowledge.

Section II:

Assessment on level knowledge regarding electroconvulsive therapy among third year B. Sc nursing students in selected nursing college:

Reveals that majority of students 15(50%) reported poor and average grade of knowledge. It is inferred that majority of students have poor and average level of knowledge in the pretest.

Section III:

Evaluation of effectiveness of planned teaching about knowledge regarding electroconvulsive therapy among third year B. Sc nursing students in selected nursing college:

The findings show that the calculated ‘t’ value was 4.29 for knowledge regarding electroconvulsive therapy. The calculated‘t’ value was much higher than the tabulated value at of at df29. This data signifies that the planned teaching was effective in assessing the knowledge of electroconvulsive therapy among third year B. Sc nursing students in selected nursing college. Hence, it was strongly interpreted that the planned teaching regarding electroconvulsive therapy was effective. So the H₁ is accepted.

Section IV:

Association of knowledge score with their demographic variables:

This section includes association of level of knowledge regarding electroconvulsive therapy with their selected demographic variables. The overall mean of electroconvulsive therapy was calculated and χ² (chi square) test was used for finding the association between electroconvulsive therapy with demographic variables.

There was no significant association between electroconvulsive therapy used and demographic variables such as age, gender, source of previous knowledge background of variables because of sample size is less..

DISCUSSION:

The findings of the study were discussed with reference to the objectives stated in chapter I and with the findings of the other sections. The present study was undertaken as, the obtain chi – square value regarding age: 0.61(P<0.05), regarding gender: 3.75(P<0.05), regarding source of previous knowledge: 1.25(P<0.05) were not significant. The obtain chi – square value regarding the fact, whether students had any medical professional in your family: 1.25(P<0.05), regarding the fact whether students have any previous knowledge on electroconvulsive therapy: 0.7(P<0.05) were not significant.

“Assessment of the effectiveness of planned teaching about knowledge regarding electroconvulsive therapy among third year B. Sc nursing students in selected nursing college.”

Distribution of subjects according to the demographic variables shows that, out of the 30 subjects,

The findings of the study show that, the mean pretest score was 6.5 with the standard deviation 2.89, whereas in post test the mean score was 16.64 with the standard deviation of 4.12. The mean difference in pretest and post test scores was 10.1. The calculated‘t’ value was 17.85; it showed that calculated‘t’ value was much higher than the tabulated‘t’ value and that there was a significant improvement in the knowledge regarding electroconvulsive therapy among third year B. Sc nursing students in selected nursing college.

Thus, the null hypothesis H₀: There is no significant difference between the pre test and post test knowledge regarding electroconvulsive therapy among third year B. Sc nursing students at p<0.05 level of significance is rejected and the research hypothesis, H₁: There is significant difference between the pre test and post test knowledge regarding electroconvulsive therapy among third year B. Sc nursing students measured at p<0.05 level of significance is accepted.

There was no significant association between level of knowledge with their demographic variables such as age, gender, source of knowledge and previous knowledge in this study.

CONCLUSION:

After the detailed analysis, this study leads to the following conclusion:

The third year B. Sc nursing students did not have 100% knowledge regarding electroconvulsive therapy. There was a significant increase in the knowledge of subjects after introduction of planned teaching. To find the effectiveness of planned teaching students ‘t’ test was applied ‘t’ value calculated, post test score was significantly higher at 0.05 level than that of post score. Thus, it was concluded that planned teaching on electroconvulsive therapy was found effective as a teaching strategy.

Demographical variables and background of variables were not show a major role in influencing the pretest and posttest knowledge score among third year B. Sc nursing students in the selected nursing college.

Hence based on the above cited findings, it was concluded undoubtedly that the prepared material by the investigator in the form of planned teaching helped the third year B.Sc nursing students to improve their knowledge on electroconvulsive therapy.

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Received on 26.05.2022 Modified on 17.07.2022

Int. J. Nur. Edu. and Research. 2022; 10(4):353-360.

DOI: 10.52711/2454-2660.2022.00082