Aromatherapy in Healthcare

October 2016

Jody Osteyee, DNP, APRN, CPNP

Aromatherapist

disclosure statement

The presenter has no relationships with any commercial entity. Products shown are for education purposes only and not for personal or professional gain of the presenter.

tell me about you…

objectives

Identify sources of reputable information about essential oil (EO) use.

Describe the science of essential oils.

Discuss the evidence-base for using EOs in healthcare.

Identify key components of EO use at healthcare facilities.

references and resources Books

Tisserand R & Young R: Essential Oil Safety. A Guide for Health Care Professionals 2nd Ed., 2014, Churchill Livingston, New York, New York

Buckle, J: Clinical Aromatherapy: Essential oils in Practice, Third Edition; 2015; Elsevier, St. Louis, Mo.

Price S & Price L. (Eds.) (2012) Aromatherapy for Health Professionals 4th ed. Edinburgh: Churchill Livingstone

Schnaubelt, K: Advanced Aromatherapy: The Science of Essential Oil Therapy, 1998, Healing Arts Press, Rochester, Vermont

Schnaubelt, K: Medical Aromatherapy, Healing with Essential Oils, 1999, Frog, Ltd., Berkeley, California

Battaglia, S. (2003). The Complete Guide to Aromatherapy 2nd ed. Brisbane:The International Centre of Holistic Aromatherapy

Singh S & E Ernst. (2008) Trick or Treatment? Alternative medicine on Trial. WW Norton & Co.

People

Robert Tisserand, Robert Young, Jane Buckle, Jade Shutes, Kurt Schnaubelt

references and resources Associations

Alliance of International Aromatherapists http://www.alliance-aromatherapists.org/.

National Association for Holistic Aromatherapy (NAHA) http://www.naha.org/about/mission/

NIH National Center for Complementary and Integrative Health http://nccih.nih.gov/health/aromatherapy

Education resources

Integrative therapies education http://www.csh.umn.edu/free-online-learning-modules/index.htm

NAHA approved aromatherapy schools; NAHA website

American College of Healthcare Sciences, Oregon http://achs.edu/resource/webinars/index.html

Aromahead Institue, School of Essential Oil Studies, Florida www.aromahead.com

Journals

NAHA Aromatherapy Journal

International Journal of Clinical Aromatherapy http://www.ijca.net/ (Peer reviewed)

International Journal of Professional Holistic Aromatherapy http://www.ijpha.com/ (Peer reviewed)

references and resources Articles

Vitale, A (2014) Initiating a Reiki or CAM program in a Healthcare Organization-Developing a Business Plan. Holist Nurs Pract. 28(6):376-380. This is the November-December issue. Useful info for program development.

Soo Lee M, Choi J, Posadzki P & Ernst E. (2012) Aromatherapy for health care: An overview of systematic Reviews. Maturitas 71; 257-260.

Campbell L, Pollard A & C Roeton. (2001) The development of clinical practice guidelines for the use of aromatherapy in a cancer setting. The Australian Journal of Holistic Nursing 8(1):144-22.

Stea S, Beraudi A & D DePasquale. (2014) Essential Oils for Complementary Treatment of Surgical Patients: State of the Art. Evidence-Based Complementary and Alternative Medicine. Article ID 726341, pages 1-6.

Joswiak D, Kinney ME, Johnson JR, Kolste AK, Griffin KH, Rivard RL & JA Dusek. (2016) Development of a Health System-based Nurse-Delivered Aromatherapy Program. Journal of Nursing Administration 46(4):221-225.

Lytle J, Mwatha C & KK Davis. (2014) Effect of Lavender Aromatherapy on Vital Signs and Perceived Quality of Sleep in the Intermediate Care Unit; A Pilot Study. AJCC 23(1):24-30.

Lua PL & NS Zakaria. (2012) A Brief Overview of Current Scientific Evidence Involving Aromatherapy Use for Nausea and Vomiting. The Journal of Alternative and Complementary Medicine 18(6):534-540.

evidence behind EOs

Blinded randomized control trials are challenging

Placebo effect

Evidence-based practice vs. practice-based evidence

Avoid pseudo-science

See books by Jane Buckle, and Shirley and Len Price

terminology Aromatherapy:

the use of essential oils derived from plants; aesthetic, clinical, holistic (Buckle);

inhalation and topical application of true, authentic EOs from aromatic plants to restore or enhance health, beauty and well-being (AIA)

also referred to as Essential Oil therapy, can be defined as the art and science of utilizing naturally extracted aromatic essences from plants to balance, harmonize and promote the health of body, mind and spirit. It seeks to unify physiological, psychological and spiritual processes to enhance an individual’s innate healing process.” (NAHA)

Aromatherapist: one who has completed recognized training in aromatherapy at the minimum level of 200 educational contact hours approved by AIA, or who has passed a standardized exam ( Aromatherapy Registration Council)

Essential oil (EO): substance distilled from aromatic plants( leaf, bark, peel, resin, etc.). Each oil has a variety of chemical constituents which determine the effect of the oil.

Holistic Nursing…

EO science

Example:

Lavendula angustifolia - Lavender

Boswellia carterii - Frankincense

Rosa damescena – Rose

Melaleuca alternifolia – Tea tree

Eucalyptus radiata – Eucalyptus

Eucalyptus dives

Eucalyptus globulus

Eucalyptus polybractea

Your EO bottles should be labeled with botanical names

Division Subdivision Class Subclass Order

Genus Family

Species

Also… variety, chemotype, hybrid

Kingdom

chemistry of essential oils The chemical composition of an oil determines it’s actions

Monoterpene alcohols low toxicity

antibacterial, viral & fungal vasoconstrictive

sedative

Sesquiterpene alcohols anti-inflammatory

antiviral

Phenols skin irritant liver toxic

nervous system stimulant

Ethers neurotoxic

psychotropic liver toxic analgesic

Peppermint, tea tree

Sandalwood, cedarwood

Oregano, thyme Clove bud, basil

chemistry of essential oils Ketones

neurotoxic (camphor, thujone)

mucolytic wound healing

analgesic

Esters antispasmodic

calming anti-inflammatory

antifungal

Aldehydes antimicrobial

anti-inflammatory calming

vasodilator

Oxides expectorant 1,8-cineole

Frankincense, camphor Lavender, ylang ylang

Lemongrass, lemon

Rosemary

establishing an essential oil program at your facility…see Joswiak et al, 2016

Holistic nursing model

Program lead

Determining EO application methods

EO supply chain

Safety

Storage

Policies and procedures

Staff education

Patient education

Documentation

Holistic nursing model: cultural readiness assessment, leadership support, budget

Program lead: certified Aromatherapist; track program and outcomes

Determining EO application methods: inhalation, topical

Essential oils: determine oils, purchase quality oils, use supply chain?, expiration, oxidation, track use

Safety: storage, EO MSDS, infection control, splashes, reactions, spills, external only, “natural does not mean harmless” (AIA)

establishing an essential oil program at your facility…see Joswiak et al, 2016

establishing an essential oil program at your facility…see Joswiak et al, 2016

Storage: cool & dark, secured, workflow friendly, pharmacy

Policies and procedures: independent nursing intervention, FDA friendly language, curb off-policy use, cautions/contraindications

Staff education: 1 hour mandatory, refresher info, job aides

Patient education: FDA friendly language

Documentation: symptom, assessment, EO, route, frequency, outcome

essential oils and symptoms

Essential Oil Indications Possible contraindications

Lavender (L. angustifolia)

• Anxiety • Insomnia • Pain

Active respiratory disease Migraine Poorly controlled seizures Pregnancy

Mandarin (Citrus reticulata)

• Nausea • Restlessness and

anxiety

Peppermint (Mentha x piperita)

• Nausea • Pain • Urinary retention**

Spearmint (Mentha spicata)

• Nausea • Anxiety

EO uses in healthcare

Settings Acute care

Intensive care

Clinics

Procedure centers

Hospice

Home health

Wound care

Nausea

Urinary retention

Alertness

Insomnia

Anxiety

Skin care

Digestion

Nasal congestion

EO aromasticks/inhalers/patches https://www.beekley.com/Aromatherapy/Elequil-aromatabs

Contact for pricing

cotton ball in a cup and fabric hearts

inexpensive

http://www.aromahaler.com

$.065

EO aromasticks/inhalers/patches

www.wyndmerenaturals.com http://aromastick.net

www.Bioessetech.com $2.29 $5.50

$2.00, blanks available

4-5 Euros

OR….Buy blanks and make your own!

Topical route

EO choices; 1-2 EOs

Carrier oil, massage lotion, emollients

Pre-mixed vs. nursing preparing: consistency, nursing workflow; Protocols

Massage techniques

Know contraindications

additional uses

Oral infection: tea tree added to toothpaste or mouthwash

Wound care: lavender/rosewood/geranium cream

Hydrosols for burns, abrasions

Insomnia;(decrease sedative use): lavender, marjoram, geranium, mandarin, cardamom, rose

Autistic patients: lavender

N & V: peppermint, spearmint, ginger

Pain: black pepper, frankincense, peppermint, lavender, rose, ylang ylang, etc.

Stress: lavender, bergamot, geranium

Urinary retention: peppermint drop in toilet

Nicotine addiction: black pepper

Hospice: hospice blends (sandalwood, rose, roman chamomile, helichrysum, etc.)

So many more

program outcomes

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20

40

60

80

100

120

140

160

Entries lavender Mandarin Peppermint Spearmint Pain Anxiety Nausea Insomnia

"dos

es"

Essential Oil Usage Primary Children's Hospital 2014

NTU

IMSU

CMU

CSU

CTU

No adverse events

Add anecdotal information

comments, questions, complaints!

My contact info:

Jody Osteyee, DNP, APRN, CPNP

(801) 662-2253

Jody.Osteyee@imail.org