Using Essential Oils to Enhance N ursing P ractice and for Self-Care

1. Using Essential Oils to Enhance Nursing Practice and for Self-Care By Melissa E. Allard, MA, RN, CCRN, CCAP, And Julie Katseres, DNP, RN, APRN, FNP-BC, CCAP

3. Introduction • With the growing popularity of integrative medicine, essentials oils have found their way back into health care. Essential oils provide a simple way to alleviate certain physical symptoms, promote emotional well being, and provide comfort. This article addresses the following: • Common uses of essential oils • Reported benefits, • Potential risks • Contraindications • Current research

4. Holistic Nursing Care • While treating a patient during illness or injury, It is important to maintain awareness of body, mind, and spirit working together. In addition to conventional Western medicine and interventions, nurses can provide comfort through simple, sensory holistic modalities such as essential oil therapy.

5. Use of essential oils in Health Care

6. About Essential Oils • The use of essential oils is believed to date back 5,000 years. • Today, oils are extracted by steam or hydrodistillation from aromatic plants. • Essential oils contain volatile, complex chemical compounds, which determine its effects. • Today, through tests such as gas chromatography and mass spectrometry, we can better understand the chemical make-up of plant essential oils. • Essential oils are known for the following properties: • Antibacterial • Antiviral • Antifungal • Anti-inflammatory

7. About Essential Oils • Sometimes called “aromatherapy” though some oils do not have a pleasant fragrance. • The therapeutic value of an oil relies on: • Its chemical constituents • Route of administration • Pleasantness or astringency of its scent • Most common routes of administration: • Direct Inhalation – breathing in the scent of the oil from a couple of drops on a cotton ball, tissue, or wick for 5-10 minutes as needed. • Indirect inhalation – breathing the scent dispersed in ambient air, either by electric diffuser or by spray bottle. • Topical application – by massage, light touch, or spray • Oral – mouth washes and gargles.

8. Absorption of Essential Oils Inhalation Topical When applied topically, certain oils have been found to make skin more penetrable, which could increase the effectiveness of other topical pharmaceuticals, or of other oils, when used in a blended concoction. • When oils enter through inhalation, the molecules stimulate olfactory pathways that are closely connected to the brains limbic system, which influences: • Heart rate • Blood pressure • Respiratory rate • Memory • Hormone levels The limbic system plays a major role in such reactions as fear and anger, and becomes highly active during emotional trauma.

9. Supportive Research • Several research studies were reviewed within this journal article to examine the effectiveness of essential oils. The findings were as follow: • Lavender and rosemary oils affected mood, anxiety levels, and alertness. • Orange and lavender oils [used prior to dental work] helped significantly reduce anxiety. • Lavender and sage oil applied topically helped reduce work-related stress [among 14 STICU nurses] • Lavender and rosemary oils inhaled [by nursing students prior to an exam] helped reduce text-anxiety

10. Methodological Criticism • Much of the research on essentials oils has been criticized for the following reasons: • Failing to incorporate randomization or control groups. • Combining aromatherapy with other complementary modalities, such as massage. • Aromatherapy may be pleasant and enjoyable for patients in stressful situations. • Aromatherapy affects people differently with based on their culture, experience, gender, and personality. • Data did not support legitimate clinical indications. • Efficacy is subjective

11. The Problems Researchers Face • Practitioners may have an impractical means of studying essential oils, as it is impossible to blind study participants to aromas. Also, many professional certified aromatherapy practitioners generally have little training in research methodology.

12. The Problems Researchers Face • While some research faces criticism, the risk of harm has consistently been found to be minimal when essential oils are used with appropriate caution and common sense.

13. Safety Precautions Essential oils are not FDA regulated in the United States. It is good to investigate the quality of the oil you purchase. Look for the following: • Location and climate in which the plant source was grown. • Harvest time and technique. • Tests to verify the chemical constituents. • The National Association for Holistic Aromatherapy (NAHA) emphasizes six factors that influence the safety of an essential oil: • Quality • Chemical composition • Method of application • Dosage or dilution • Integrity of skin • Age of client

14. Use of Oils in the Hospital Setting • All oils used in a hospital or clinic setting must have a material safety data (MSD) sheet, which contains the following information: • Oil’s toxicologic properties • Potentially hazardous ingredients • First-aid information

15. 12 • Keep oils away from children and pets • Avoid sunlight and tanning booths for 24 hours after a photosensitizing oil is used • Avoid prolonged use of the same oil • Research any oil before using it on yourself of your patient • Do not use undiluted oils • Perform a skin patch test with any suspect allergic reaction • Know the safety data on any oil you use • Use caution with oils and pregnancy • Avoid oil contact with the eyes • Keep all oils away from open flames • Ensure adequate ventilation with oils • Do not use oils internally unless properly trained Recommended safety Precautions

16. Essential Oils in Acute Care Guidelines considerations In clinical settings, oils are not considered FDA regulated and therefore cannot claim to treat disease. The language used when documenting must be monitored. For example: “minimize discomfort” not “treat pain” “promote calm and well-being” not “treat anxiety” • To support safe use of oils in hospitals and other health care settings, a well-developed protocol is required. It is necessary to have the following: • Clear guidelines for training staff • Identifying reputable suppliers • Filing MSD sheets • Determining routes of administration

17. Essential Oils in Health Care Settings Hospice Long-term care For elder patients, the use of oils may help reduce polypharmacy. Essential oils that have been found to be safe to use for such at-risk populations and frail elders are: Lavender Tea tree Eucalyptus Rose • Hospice nurses have long promoted the use of essential oils in the home setting. Common delivery is through: • Steam – float 1-3 drops of oil in a bowel of hot water and inhale the aroma • Therapeutic massage

18. FYI: Making an Essential Oil Inhaler Stick • Supplies • Blank inhaler with a wick • Medicine cup • Essential oil(s) • Gloves • label • Apply gloves and then place 20-25 drops of your choice of essential oil(s) in a medicine cup. (Swirl to combine if using more than one oil). Place the wick into the cup until all the oil is absorbed. Place the wick into the inhaler tube, secure cap, and tightly screw the inhaler cover onto the inhaler tube. Label the tube with the essential oil used.

19. Reference Allard, M., Katseres, J., (2016). Using Essential Oils to Enhance Nursing Practice and for Self-care: A simple, sensory way to provide comfort and decrease certain symptoms. American Journal of Nursing, 116, 42-49.