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Department: Wellness Mention

Have you considered aromatherapy?

Perkins, Amanda DNP, RN

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doi: 10.1097/01.NME.0000717688.95931.da
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Aromatherapy—the use of essential oils to improve health and well-being—is a widely used complementary and alternative medicine (CAM) therapy. Often incorporating the sensory experiences of smell and touch, aromatherapy can be a beneficial adjunct to other methods of patient care.

Aromatherapy has been shown to be effective in controlling a variety of symptoms, including, but not limited to, pain, anxiety, and nausea, as well as having antiviral, antibacterial, antifungal, insecticidal, and antioxidant properties. It can also cause changes in BP, heart rate, respiratory rate, and cortisol levels. Essential oils can help increase relaxation and decrease anxiety through the stimulation of the olfactory system and release of nerve mediators. Research has also shown that aromatherapy may be beneficial in reducing postoperative pain and nausea.

Aromatherapy is generally well-tolerated, inexpensive, noninvasive, and without adverse reactions. In addition, it can be used by patients independently, which can help them gain autonomy and a sense of control. When used for pain control and anxiety reduction, aromatherapy can lead to decreased use of pharmacologic treatment methods, reducing adverse reactions and the risk of addiction. Medications used for pain and anxiety may cause amnesia, sedation, impaired concentration, and depression—none of which occur with the safe use of aromatherapy.

At least 3,000 essential oils are known, but this article will only focus on a few common types, discussing their uses and the nurse's role in aromatherapy.

Essential oils explained

Essential oils are extracted from stems, leaves, bark, flowers, roots, seeds, resins, and peels. Essential oil molecules are very small, which means they can penetrate the bloodstream relatively quickly. Each essential oil contains anywhere from 60 to 300 chemicals. The therapeutic actions and effectiveness of essential oils depend on the method used to obtain them and the area in which the plants were grown.

A variety of methods can be used to obtain essential oils. Steam distillation is one of the most common ways, which requires a pressurized system that allows for strict temperature control. Water is used to remove the essential oil and, when heated, produces steam. For peels, a common method of obtaining essential oils is expression (grating/grinding). Unlike steam distillation, expression doesn't require heat. Another method is carbon dioxide extraction, in which carbon dioxide is used as a solvent.

Adulterated essential oils are diluted, which increases volume but also compromises the quality and raises the risk of adverse reactions. When using essential oils, only use those that are therapeutic grade.

It's important to understand that tinctures and essential oils aren't the same thing. Tinctures are made using alcohol as a solvent and they contain water-soluble and oil-soluble chemicals, whereas essential oils contain oil-soluble, low-molecular-weight chemicals. Additionally, tinctures are typically given orally or sublingually and are less concentrated than essential oils.

Choosing the right essential oil

The following are common essential oils that may be used:

  • lavender
  • chamomile
  • peppermint
  • tea tree
  • ginger
  • clary sage
  • clove
  • eucalyptus
  • lemon
  • mandarin
  • orange
  • rosemary
  • sweet marjoram.

Lavender (Lavandula officinalis, Lavandula angustifolia)

Lavender has been shown to help with anxiety, stress, pain, muscle cramps, headaches, irritability, nausea, sleep, cuts, burns, tissue repair, muscle fatigue, stimulation of the immune system, and dysmenorrhea. It has a calming effect and may improve a person's mood. It's also been shown to be effective against bacteria, filamentous fungi, and yeasts. Lavender may be beneficial for patients who experience migraines, in addition to those who have anxiety preoperatively.

One component of lavender, linalool, has been shown to have an inhibitory effect on the limbic system and autonomic neurotransmission, which can help individuals with anxiety and stress management. Another component, linalyl acetate, is also known for its sedating effects.

Lavender is typically well tolerated by patients and has a very low risk of toxicity and allergic reactions. It's also one of two essential oils that can be applied without dilution.

Chamomile (Chamaemelum nobile)

Research has shown that when combined with lavender, chamomile can decrease anxiety in a variety of situations, such as during dental procedures or for patients requiring mechanical ventilation. Chamomile has been shown to play a role in cortisol secretion and it has chamazulene, which has both anti-inflammatory and analgesic properties.

Peppermint (Mentha piperita)

Peppermint is one of the most popular essential oils used today. It has the following components that have beneficial effects: menthol, menthofuran, terpinene, menthone, limonene, cineole, phellandrene, and alpha-pinene. Of these components, menthol is the major compound, which has been shown to slow down proliferation of bacterial cells. The menthol component of peppermint oil can also help with acute and inflammatory somatic conditions, as well as reduce bacteria known to cause dental caries and periodontal disease.

Peppermint has been shown to help with upset stomach, nausea, vomiting, headache, pain, and symptoms associated with irritable bowel syndrome (IBS). Although oral intake of essential oils is typically discouraged, peppermint oil capsules may be used with IBS. Some studies have shown that peppermint oil inhaled postoperatively decreases the need for intermittent catheterization. Peppermint is also an antispasmodic and smooth muscle relaxant.

Tea tree (Melaleuca piperita)

Tea tree oil has the following compounds that play a role in its healing properties: terpinen, alpha-pinene, and 1,8-cineole. Like lavender, tea tree oil can be applied topically without dilution. Topical application of tea tree oil acts as an antimicrobial and anti-inflammatory agent. Tea tree oil has been used to treat acne, athlete's foot, lice, nail fungus, dandruff, and insect bites. Some studies have shown that Methicillin-resistant Staphylococcus aureus is susceptible to tea tree oil. When combined with lavender, tea tree oil has been shown to help with lice infestations. Tea tree oil shampoo can be used for both the treatment of lice and dandruff control.

Note that the applications for tea tree oil discussed here pertain to topical application of the essential oil. Much of the research conducted on tea tree oil is based on topical application. Some research has shown that when diffused, this oil can help clear up problems within the respiratory tract, such as chest congestion and cough. It has also been shown to boost the immune system.

Ginger (Zingiber officinale)

Ginger contains gingerols, compounds responsible for the smell of ginger and some of the benefits associated with this essential oil. Ginger has been shown to be beneficial for nausea and vomiting, including nausea associated with pregnancy, motion, and surgical procedures; decreased appetite; indigestion; flatulence; constipation; headache; rheumatic disease; colds; and pain. Ginger can increase gastric tone, motility, and emptying. It has also been shown to have beneficial effects against Escherichia coli.

For information on the other oils listed, see Selected essential oils and indications.

Use in practice

Anyone using or recommending aromatherapy should have knowledge regarding safety, clinical protocols, appropriate product selection, and application/use of essential oils. Before using aromatherapy in patient care, determine patient preferences regarding scent. Essential oils can be used as aromatherapy blends, combining different oils together for a complementary effect.

Essential oils can be applied topically or diffused into the air. Ensure that the patient understands essential oils shouldn't be taken orally, except in a few instances. Before, during, and after aromatherapy, assess for sensitivities and allergies.

When using aromatherapy, one to two drops of an essential oil can be placed on a cotton ball and given to the patient for inhalation. One to five drops of essential oil may be placed in hot water and inhaled for 5 to 10 minutes. Diffusers, burners, nebulizers, and vaporizers can also be used. The choice of which method to use depends on a variety of factors, including equipment available at the facility, equipment available in the patient's home, and patient preference.

Essential oils can also be applied topically by mixing three to six drops in 25 mL of lotion or a carrier oil. This is because essential oils aren't soluble in water. When applied topically, essential oils can be absorbed through the skin. Research has shown that aromatherapy massage can help individuals with anxiety, depression, and sleep disturbances. Another important component to consider with aromatherapy massage is effective communication. Nurses as skilled communicators can combine therapeutic communication with therapeutic touch/massage.

Using essential oils in a bath can provide inhalation and skin effects. A warm bath will increase absorption of the essential oil. When using essential oils in a bath, four to six drops of the chosen essential oil or essential oil blend should be added to milk or a carrier oil and then added to the bath. Essential oils can also be added to Epsom salts and then added to the bath. Aromatherapy baths have been shown to aid with relaxation and sleep. Oils that are irritating, such as peppermint and citrus, should be avoided.

Compression is another method of essential oil application. Four to six drops of an essential oil or essential oil blend should be added to warm water. Soak a compress in the water, wring it out, and apply to the patient's body. The area can then be covered with a plastic wrap to retain moisture. These compresses should only be applied for a maximum of 4 hours.

When inhaled, essential oils have the fastest effect. Additionally, inhaled essential oils act as a sensory stimulant that travels to the olfactory bulb where impulses are sent to the brain. Essential oils can also enter the lungs, followed by the circulatory system. When it comes to aroma processing, the amygdala and hippocampus play an important role. The amygdala is the area of the brain associated with emotions and the hippocampus is the area of the brain associated with memories.

Nursing considerations

When implementing aromatherapy in the clinical setting, nurses may encounter resistance from other healthcare staff, including other nurses and physicians. Providing the appropriate education will help gain buy-in from members of the healthcare team. When it comes to education, nurses can participate in aromatherapy programs. Many of these programs provide continuing-education credits and some provide certification.

Ask patients about the use of CAM therapies during the health history. Some patients may be afraid or embarrassed to discuss use of these therapies for fear of being judged. Be clear when asking about the use of CAM therapies because patients may not understand the importance of sharing this information to ensure that these therapies are being used appropriately and safely.

Before, during, and after initiation of aromatherapy, the nurse should do the following:

  • assess for safety
  • assess for appropriate use
  • encourage patients to ask questions and answer all questions thoroughly
  • assist patients with finding appropriate and evidence-based information
  • evaluate for effectiveness
  • document findings.

Many facilities don't have clear guidelines in place regarding the use of aromatherapy. Nurses can play an important role in the development of guidelines, policies, and procedures. When developing guidelines and policies, list indications for the essential oils available on the unit or in the facility. Provide clear instructions on when and how to use the essential oils. Lastly, determine how the use of aromatherapy will be evaluated for effectiveness.

More research is needed regarding the use of aromatherapy for therapeutic purposes. Nurses can participate in new research pertaining to aromatherapy and its application in the healthcare setting.

Safety

Although typically safe, when working with essential oils, the nurse must understand what essential oils are being used and how to safely use them because they can be toxic if used incorrectly. Provide the patient with education about indications, safety, and effectiveness. Only therapeutic-grade essential oils should be used.

Essential oils should never be applied undiluted, with the exception of lavender and tea tree oil. Patients should never take essential oils orally unless under the supervision of a healthcare provider. Store essential oils in a cool area away from sunlight and flames. Undiluted essential oils can degrade some plastic and should be stored in glass.

Caution should be used when working with patients who are pregnant. Essential oils should also be used cautiously with pediatric patients. Always keep essential oils out of the reach of children and pets to decrease the risk of poisoning. Lastly, it's important to know that some essential oils can change medication effectiveness.

Communication is key

CAM therapies, such as aromatherapy, are embraced and used by many individuals around the world, highlighting the importance of nurses understanding these therapies. Although CAM therapies are frequently and commonly used, research has shown that there's a communication gap between healthcare team members and patients. Talking openly with patients about aromatherapy will increase safety and prevent injury. Additionally, nurses can enhance safety by educating themselves about aromatherapy and helping implement it in healthcare settings.

Selected essential oils and indications

  • Clary sage (Salvia officinalis): abdominal tension in women, muscle cramps, cortisol levels, and the control of sebum production
  • Clove (Syzygium aromaticum): used frequently in dentistry; also has antifungal properties that inhibit the growth of some bacteria
  • Eucalyptus (Eucalyptus globulus, Eucalyptus radiata): throat infections, cough, bronchitis, sinusitis, asthma, and other respiratory-associated conditions; has also been shown to work against both Gram-positive and Gram-negative bacteria
  • Lemon (Citrus limon): immune system stimulation, digestion, nausea, vomiting, skin conditions, and antifungal activity especially against Candida species
  • Mandarin (Citrus reticulata): anxiety, stress, digestion, nausea, restlessness, constipation, and insomnia
  • Orange (Citrus sinensis): anxiety, nervousness, insomnia; has also been shown to be beneficial against S. aureus
  • Rosemary (Rosmarinus officinalis): antimicrobial properties against bacteria and yeast; effective against E. coli and S. aureus
  • Sweet marjoram (Origanum majorana): pain, headache, muscle spasm, anxiety, stress, insomnia, and constipation

did you know?

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Evidence of essential oil use can be identified up to 5,000 years ago. In ancient Egypt and the Middle East, essential oils were used for scent and healing. Additionally, Greek and Roman medicine incorporated the therapeutic application of essential oils. In fact, 2,500 years ago, Hippocrates talked about the benefits of aromatic baths and scented massage. In the 1800s, an association between essential oils and disease prevention was noted, leading to studies relating to the antimicrobial properties of essential oils. In 1910, French chemist René-Maurice Gattefossé coined the term aromatherapy after burning his hands and placing them in lavender, which he found helpful for pain control and wound healing. He then started using lavender for wound healing and anesthetic properties in hospitals during World War I. It's also interesting to note that Florence Nightingale was the first nurse to use essential oils in therapeutic care. She was known to apply lavender to wounded soldiers during the Crimean war to help calm them.

on the web

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

Canadian Federation of Aromatherapists:www.cfacanada.com

International Federation of Aromatherapists:www.ifaroma.org

National Association for Holistic Aromatherapy:www.naha.org

National Cancer Institute:www.cancer.gov/about-cancer/treatment/cam/patient/aromatherapy-pdq

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