patient satisfaction is the most important criterion for measuring the quality of care , because quality of care depends on the level of patients satisfaction , and can be used for evaluation of the care process ( 1 ) . as the main goal of any healthcare system is to respect patients needs and expectations , meeting their expectations satisfaction , which is considered an important factor in medical care , facilitates patient cooperation and increases his or her contribution in the treatment procedure ( 3 ) . patient satisfaction resulting from nursing care increases the rate of adherence to drug therapy and post discharge care ( 4 ) . increasing the level of satisfaction among patients can only be met through better interaction between patients and nurses by increased involvement of the nurses , continuous care giving , competence of the nurse , and good communication ( 5 ) . nurses , because of the inherent nature of their job , have much closer and continuous contact with patients compared to the other medical staff . providing supportive care is one of the main tasks of nurses , which usually is also one of the main sources of support for the patients and their families during the illness and stress ( 7 ) . supportive care consists of a set of general and specific therapeutic interventions provided by the nurse , intended for the treatment and support of the patient ( 8) . previous studies have shown that supportive nursing care for patients undergone invasive procedures , especially in patients with cancer , have improved their mood ( 9 ) , and reduced their anxiety and depression ( 10 ) . electroconvulsive therapy ( ect ) is one of the main therapeutic methods for patients with severe mental disorders , which its effect is associated with convulsions ( 11 ) . annually , about 100000 patients in the usa and more than one million patients throughout the world receive ect ( 12 ) . considering the high prevalence of mental disorders , their relevant complications and high efficiency of ect , the extensive application of ect has been restricted for years by the lack of public acceptance secondary to continuous social , political , and legal attacks against this therapeutic method ( 14 ) . based on the conducted studies , 90% of the public opinion considers that the main sources of data regarding this method are collected from the patients received ect ( 15 ) . in the light of such results , misconceptions and stories , the use of this method is associated with misunderstanding and stigma , leading to lower satisfaction ( 16 ) . also , the unrealistic view of media toward the ect and lack of proper training necessary to eliminate the gap between falsification and reality are the other reasons contributing to satisfaction reduction ( 12 ) . patients with lower satisfaction do not usually observe medical advices and are rarely trainable ; they have no control over their behavior , which leads to continuous hospitalization ( 17 ) . thus , it is of great importance to consider patient s satisfaction and set standards to promote satisfaction levels . studies conducted in iran on patients receiving ect have mostly focused on the efficiency and complications of this method , and areas such as satisfaction before , during , and after ect psychiatric nursing care and trainings have been overlooked , resulting in fear , concern and dissatisfaction concerning ect . although cognitive impairment and physical complications related to ect are frequently considered , patient s satisfaction after this therapeutic method is almost neglected ( 19 ) . also , no study was found regarding the effect of supportive care on the level of satisfaction in patients who receive ect . considering the extensive use of ect in iran ( 20 ) , researchers conducted this study to determine the effect of supportive nursing care on the satisfaction of patients receiving ect . they also wanted to show the importance of providing proper supportive nursing care to increase the level of satisfaction in these patients , if any . this study was a randomized clinical trial performed in baharan psychiatric hospital , affiliated to zahedan university of medical sciences , zahedan , iran , from july to august 2013 . the research started after receiving the introduction letter from the research deputy and approval of the ethics committee of tabriz university of medical sciences , tabriz , iran . baharan psychiatric hospital with 5 wards and 80 beds is the only governmental , referral , and specialized hospital in southeast of iran . this research is also registered in the iranian registry of clinical trials under the code irct201306036834n6 . inclusion criteria were age  18 years , ability to read and write , no physical disorder that can cause cognitive impairment , and no cognitive impairment and impaired reality perception . exclusion criteria were having acute psychosis symptoms , withdrew from the study , and receiving less than 4 sessions of ect . to determine the sample size , a pilot study was conducted on 24 patients receiving ect , who had the inclusion criteria . considering  = 0.05 , power = 0.9 , and based on the mean difference and standard deviation after and before the intervention ( mean  sd before intervention was 24.33  2.42 and after intervention was 0.5  4.54 ) , 30 subjects were estimated for each group based on the sample size formula ( z1-/2 = 1.96 and z1- = 1.28 ) . then , considering the possibility of subject attrition , 35 patients were allocated for each group , which totalized 70 eligible patients in the study . a total of 186 patients were assessed for eligibility by convenience sampling method . of this people , only 70 patients were eligible ( 98 patients not meeting inclusion criteria and 18 patients refused to participate ) . then , through simple random allocation method , 35 patients were indiscriminately assigned to the intervention and 35 to the control group ( figure 1 ) . the first part included demographic information such as age , gender , marital status , and level of education , whereas the second part contained webster s satisfaction questionnaire ( of the received care ) comprising 15 items : 10 items evaluate general satisfaction of the received services , and 5 items ( 2 - 5 , 14 ) score the level of patient s satisfaction of interventions during the anxiety . the scoring phrases were set as follows : 1 ) totally disagree , 2 ) disagree , 3 ) neutral , 4 ) agree , and 5 ) totally agree . the sum of the scores of these 15 phrases represents the overall scoring , ranging from 15 to 125 . the higher the average scores , the higher the patients ` satisfaction of the received care . the reliability coefficient for the questionnaire was measured to be 0.93 . in the current study , the validity of the translations and concepts was compared with that of the english original text , after translation to persian . then , the questionnaire was given to 10 faculty members of tabriz university of medical sciences , tabriz , iran and any necessary corrections were applied after receiving their comments . also , the reliability was determined from the aspect of reproducibility ( interclass correlation ) at 0.80 , based on the pretest and posttest conducted on the 24 subjects . to conduct the study , the researchers gave some information regarding the study to the eligible volunteer patients who were expected to receive ect . then , the written informed consent was obtained and subjects were randomly allocated into the intervention and control groups . first , the pretest satisfaction was determined through the questionnaire and subjects with lower or normal satisfaction were selected for the study . supportive nursing care was given to the intervention group by the nurses interested in participating in the study . the nurses had been trained the executive skills based on a booklet provided by the researcher a week before the start of the study . to evaluate the usefulness of the trainings , nurses feedback was obtained through pretest and posttest questionnaires designed according to the handbook . the handbook was selected from the related articles , reference books , and journals , considering the aims of the study . interventions were given by the end of the ect sessions , which were at least 4 sessions . interventions comprised the proper communication with the patient and providing supportive care in the informational , emotional and physical aspects such as giving information to the patient , encouraging the patient to express his feelings , evaluating beliefs and negative fears of the patient , supporting the patient to decide on ect , explaining the reasons for using ect , its advantages and disadvantages , explaining the responsibility of medical group members , and answering the questions before , during , and after receiving ect . it also implied giving physical care such as keeping the patient fasting , bladder evacuation , taking jewelry , and metal ornaments off , making a proper venipuncture , and taking care of the patient in case of post - ect cognitive defects . the general care and training such as ensuring patients fasting , bladder evacuation , and taking off the jewelry and metal ornaments were performed by the control group nurses . at the end of the last ect session , the patients satisfaction were determined in both intervention and control groups , and to avoid post - ect cognitive defecting factor , the questionnaires were completed 6 hours after receiving ect . descriptive statistics such as frequency , rate , mean , and standard deviation were employed to describe participants characteristics and their satisfaction level . also , because of the normal distribution of data in both groups within the satisfaction variable confirmed by kolmogorov - smirnov test , independent sample t test was performed to compare satisfaction scores before and after the intervention in both groups ( paired samples t test ) , and to compare satisfaction mean differences of both groups before and after the intervention . collected data were analyzed using spss software ver.15.0 ( spss inc . , chicago , illinois , the usa ) . descriptive statistics such as frequency , rate , mean , and standard deviation were employed to describe participants characteristics and their satisfaction level . also , because of the normal distribution of data in both groups within the satisfaction variable confirmed by kolmogorov - smirnov test , independent sample t test was performed to compare satisfaction scores before and after the intervention in both groups ( paired samples t test ) , and to compare satisfaction mean differences of both groups before and after the intervention . to compare demographic information , such as gender , marital status , occupation , and level of education , chi - squared test showed similar results for both groups . also , results of the independent t test showed insignificant difference ( t = -0.03 , p < 0.05 ) in the mean age between the intervention ( 41.00  10.90 y ) and control ( 41.08  11.22 y ) groups . results of the paired t test showed significant differences between the mean satisfaction scores of the intervention group , before ( 37.37  5.76 ) and after ( 54.71 5.27 ) the intervention . this test also indicated significant differences between the mean satisfaction score of the control group , before ( 38.85  7.51 ) and after ( 36.28  7.00 ) the intervention ( figure 2 ) . results of the independent t test showed no significant difference between the mean satisfaction scores of the intervention and control groups , before the intervention ( p = 0.35 ) . however , the results of this test indicated significant difference between the mean satisfaction scores of the two groups , after the intervention ( table 2 ) . analytical results of levene s test ( f = 0.23 , p = 0.63 ) revealed equality in dependent variances of variables in the two groups of the study , and based on the result of kolmogorov - smirnov test ( statistic = 0.12 , sig . = 0.13 ) the data were normally distributed , which was used as a necessary default in the analysis of covariance ( ancova ) . results of the ancova test showed a significant difference between the mean satisfaction scores of both groups after intervention ( p < 0.001 ) . considering the effect of demographic variables such as age , gender , marital status , education , and occupation , there was a significant difference between the mean satisfaction scores of both groups , after intervention ( p < 0.001 ) , which means supportive nursing care may increase the level of satisfaction . comparing the mean satisfaction scores of both groups showed significant differences between the mean scores of patients before and after intervention . however , the mean satisfaction score of the intervention group increased from 37.37 (  5.76 ) to 54.71 (  5.27 ) , and , in contrast , decreased in the control group from 38.85 (  7.51 ) to 36.28 (  7.00 ) . there was a significant difference between the mean satisfaction scores of the two groups , before and after the intervention . increase in the mean satisfaction after receiving ect in the intervention group might be due to the fact that patients were given the chance to express their feelings , providing proper information from reliable references regarding the ect procedure , and useful trainings . the results of the current study showed that providing supportive care in the informational , emotional , and physical aspects may have positive effects on the patients who receive ect . 21 ) also conducted a study on the level of satisfaction from ect among the patients and their relatives . results of their study showed that the level of satisfaction regarding ect among the patients relatives was higher than the patients themselves . participants also complained about the lack of information before receiving ect , fear of ect , and continuous cognitive impairment ( 21 ) . the results of the current study indicated the importance of satisfaction and identified factors causing dissatisfaction in the patients who receive ect . the positive effects of supportive nursing care on the informational , emotional , and physical aspects of this variable were also indicated . ( 22 ) conducted a study on the level of satisfaction after receiving ect and its association with the treatment - related variables like memory disorders , and also patient - related variables such as level of depression and negative emotions . the results of their study showed that the level of post - treatment complications and giving supportive care based on the symptoms are the most important factors associated with the level of satisfaction . in the current study , providing supportive care in the 3 aforementioned aspects reduced mental complications associated with this therapeutic method and also indicated the importance of patients satisfaction ( 22 ) . uzun conducted a study on the level of patients satisfaction from the nursing care in a world class university hospital in turkey . results showed that the most dissatisfying factors regarding nursing care were the level of tangibility , reliability , accountability , assurance , and empathy , which have to be improved . the results of this study also emphasized on the important role of nursing care on the patients satisfaction ( 23 ) . the informational , emotional , and physical aspects assessed by this study are similar to those of the current study . providing such supportive care studies conducted on ect receiving patients have mostly focused on the physical complications associated with this therapeutic method , while in the current study , the effect of care and training on the level of satisfaction were evaluated . in this regard , the study of najafi et al . ( 24 ) on the effect of video training on the post - ect complications revealed that video training before treatment may reduce complications such as headache , memory disorder , and vomiting . training provided in this study was compatible with the informational and physical supportive cares of the current study , while reduced physical complications result from this therapeutic method applied efficiently . the current study evaluated the effect of such supportive care on the level of satisfaction and indicated that it can increase the level of satisfaction in ect receiving patients . ( 20 ) evaluated the effect of training on the consciousness and cognitive status of the ect receiving patients . the results of their study showed that training before ect may affect the cognitive status of the patients . patients who were trained regarding the advantages , procedure , and temporary complications of this therapeutic method , had a better cognitive status ( 20 ) . the training provided by their study is compatible with the informational supportive care of the current study . in our trial , supportive care was provided by trained nurses and results showed that the level of satisfaction in the intervention group was high . in the present report , the important role of supportive nursing care was investigated and the results showed positive effects of these supports on the satisfaction associated with ect . the results of the current study are also in line with those of eghtedar et al . ( 25 ) who conducted a trial study on the quality of life of 100 women with breast cancer who received supportive nursing care in the informational , emotional , and physical aspects . the results of their work showed that improving supportive nursing care may improve the quality of life of the patients with breast cancer ( 25 ) . ( 26 ) also indicated the important role of supportive care in decreasing the symptoms of mental disorders . they evaluated the effect of supportive emotional care on the level of anxiety and depression in 507 chinese elderly and indicated that supportive emotional care plays a more important role than instrumental supports in mental disorders ( 26 ) . the results of their study are compatible with those of the current study regarding emotional support . the results of the current study showed that supportive nursing care increase the patients satisfaction when receiving ect . considering the high prevalence of mental disorders and their huge associated psychological burden , and in view of the high efficiency of ect , this treatment was considered as a useful and effective therapeutic method , which is widely used . however , it sometimes results in patients dissatisfaction due to the lack of public acceptance , negative attitude toward this therapeutic method , and invalid references . because dissatisfaction is associated with failure to follow therapeutic recommendations and loss of confidence to control their behavior at home ( 26 ) , to make these patients satisfied , providing supportive interventions seems to be crucial . nurses have more communication and interaction with patients , due to the nature of their job . therefore , providing proper and standard supportive nursing care may play an important role in the patients satisfaction from this therapeutic method . these interventions are easy to apply and may come along naturally with the duties of the nurses . also , nursing authorities and managers may prepare the nurses to provide specific care and support for ect receiving patients through holding training courses . identifying the control group subjects by the nurses through their contact with however , this issue was somewhat controlled through training the nurses of the evening and morning shifts , gaining their support , participation through promotional programs , and cooperation with the management system . however , more targeted actions are recommended to minimize possible exchange of information between the intervention and control groups . randomized controlled trial study design and supplying of educational content of ect supportive nursing care for nurses are the strengths of current study . small sample size and caution in generalizing the results ( because of its implementation in local area ) are limitations of this study too .
background : patient satisfaction is the most important criterion in evaluating the quality of care . besides , its assessment in patients with severe mental disorder treated by electroconvulsive therapy ( ect ) is highly appropriate . 
 the ect is accompanied by lower satisfaction and may exacerbate the patients condition.objectives:the current study aimed to determine the effect of supportive nursing care on the satisfaction of patients receiving ect.patients and methods : this randomized controlled trial was conducted in the education center of baharan psychiatric hospital , zahedan , iran . 
 seventy hospitalized patients receiving ect were randomly divided into two groups of control ( n = 35 ) and intervention ( n = 35).the socio - personal and webster satisfaction questionnaire were used as data collection tools . 
 the intervention group received supportive nursing care by nurses trained in informational , emotional , and physical aspects . 
 the control group received only regular nursing care . 
 the levels of satisfaction were measured and compared between groups , before and after the intervention . 
 data were analyzed using the spss software , and chi - square , independent and paired t tests , as well as covariance analysis were performed.results:the results showed similarities in socio - personal characteristics of both groups . 
 however , there was a significant difference ( p < 0.001 ) between the means of satisfaction in the groups , predominantly for the intervention group . in other words , a significant difference 
 ( p < 0.001 ) was observed between the means of satisfaction of the intervention ( 54.71  5.27 ) and control ( 36.28  7.00 ) groups after intervention by controlling the effect of socio - personal variables.conclusions:results of the current study confirmed the effect of supportive nursing care on increasing the level of satisfaction in ect receiving patients , recommending the use of this therapeutic method .