Changing the Model

A mong the diplomas and memorabilia adorning Katherine Pachkowski’s bright, cheerful office is a contraption no bigger than a shoebox, cloaked in wood with a metal face sporting buttons and a big dial.

“That is an old-school Electro Convulsive Therapy machine that they used in the former Brandon Mental Health Centre,” says the Brandon University alumna and newly-minted Master’s degree holder in Bioethics from McGill. “What people refer to as ‘shock therapy’.”

While her particular device is no longer in service, Pachkowski says that Electro Convulsive Therapy is still prescribed treatment, albeit a kinder and gentler version than what has been portrayed in movies and television shows over the last two generations.

“If you ask anyone on the street,” she says, “they are likely to be distressed because of movies like One Flew Over the Cuckoo’s Nest where patients are pinned down and shocked. It did used to look a lot like that. The way it’s done now is less likely to cause distress among patient and practitioner.”

Pachkowski’s shock therapy keepsake, more than just a conversation piece, is a window into her work on the leading edge of the ethics of mental health care, exploring the moral distress practitioners may feel in the delivery of certain types of treatment and therapy.

“There is only a small pocket of people thinking and talking about this subject,” says Pachkowski. “It’s on the radar, but in terms of being explicitly addressed in the mainstream of psychiatric nursing, it’s not. What I am doing is bringing it out of psychiatry and into psychiatric nursing. That’s where my work is unique.”

A product of Ethelbert, MB, population 300, a two-and-a-half hour drive north of Brandon, Pachkowski was destined for academic life.

“My parents used to work for University of Alberta, so academiawas always important. It was a no-brainer that I would attend university. Two of my older siblings came to Brandon University,so it just seemed natural for me to come here. I was in Biology first, but found myself drifting into Psych Nursing instead and loving it.”

After graduating in 2004, she moved to Portage la Prairie to work in the Manitoba Developmental Centre, all the while maintaining a relationship with BU as a research assistant with the Rural Development Institute (RDI). In 2005, she took a job in Dauphin at the Parkland Adult Psychiatric Unit.

“I was a nurse on the floor,” she recalls, “working with patients who were acutely mentally ill, people who are no longer safe or able to be in the community. It was an absolutely wonderful experience, very rewarding but challenging, too.”

Pachkowski returned to BU in 2007, as a full-time instructional associate, teaching labs and clinics. “One of the chief selling points of me coming here, is this department is very supportive of continuing education.”

In 2010, she took a leave of absence to pursue a Master’s Degree at McGill University. “I returned to BU to work and finish my thesis, and graduated with my Master’s in Bioethics in February of 2013. Shortly after which, I accepted a position as Assistant Professor.”

Bioethics deals with the ethical implications of biological research and applications in medicine, “the study of how we, as medical practitioners, treat people,” says Pachkowski.

“It’s the ethics of how we care for people, balancing human rights with doing good things in a medical environment. I find it fascinating because in my personal experience, there wasn’t a lot of conversation about that in mental health. I saw that as an opportunity to look at the ethics of mental health care, which always comes with a list of highly specific ethical issues.”

Her interest in the field began at an early age when she volunteered in her local hospital, and percolated as a Psychiatric Nursing student at BU. “I always had an interest in human rights issues,” she observes, “and that has guided a lot of what I have done.”

Currently collaborating with BU colleagues on research projects, Pachkowski is anxious to begin her own work, possibly by the summer of 2014. “I want to start looking at the ethical tensions that arise when using particular paradigms or conceptions of how we should treat mental illness, and the moral distress that mental health practitioners may experience when they practice within the confines of those conceptions.”

As an example, Pachkowski explains that, often in the treatment of mental illnesses, patients are given specific medications which may have nasty side effects. “Some practitioners, especially nurses, may feel uncomfortable in their role in having to give people medications that, in some cases, almost makes them sicker.

There’s a lot of evidence suggesting that nurses who do things that are against their personal moral compass experience burnout faster. This kind of result could be not just an important finding, but also a window into other effects current practice has on practitioners and patients. For now, my focus will be on the effects on nurses of treating patients within specific treatment models.”

She looks across her desk to the relic Electro Convulsive Therapy machine. “It’s more than just an interesting gizmo,” she says,
reflecting. “It does represent where we came from, and how far we have come. That’s what I want to do in my work—change the model for the better.”

This article first ran in Alumni News, a biannual publication produced by the Brandon University.

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