A new aromatherapy program at HUP is helping patients manage their symptoms … without the use of drugs. “It’s a part of integrative medicine, viewing the patient as a whole, ” said Christin Reddy, MSN, RN, OCN, of Rhoads 3, an oncology unit. The nurse-driven program does not take the place of treatment; rather, it is complementary. “It’s something else in a nurse’s toolbox to manage symptoms without the side effects commonly seen with pharmacologic interventions.”
Aromatherapy uses small doses of extremely concentrated essential oils from plants. Nursing created an educational handout to help patients and families better understand aromatherapy and how it might help with specific symptoms. For example, lavender can help reduce pain, stress or trouble sleeping, while peppermint oil or ginger oil can help with nausea or an upset stomach. Knowing when to use which essential oil is important but it’s crucial to know when not to use certain oils. “Not having good information can lead to unsafe uses,” said Susan Kristiniak, DHA, MSN, associate director of Palliative Care for Penn’s Health System.
HUP offers patients both self-inhalers and lavender lotion used in hand massage. The “sniffers,” which patients are taught to use, provide more control over symptoms while in the hospital and at home. The hand massage, performed by nurses, elicits a relaxation response but also has a positive impact on the nurse/patient relationship. “Nurses are present in the moment, talking with patients as they massage their hand and making a connection,” Reddy said. “This is a great intervention. It allows us to give the patient our full attention.” And, when it works, “relief comes quickly,” she said. “It takes about .5 seconds for a smell to register in our brain, almost twice as fast as pain.”
Nurses have been enthusiastic about bringing this practice onboard, said Kristiniak, who is also a nurse aromatherapist and leads the program. “When these therapies are integrated into nursing practice, patients rest and are more comfortable, which make families happier as well.” Initially used on HUP’s oncology units, the program has expanded to help transplant patients and patients receiving outpatient treatment.
Patient Reactions Tell the Story
Patients are asked to self-rate aromatherapy’s impact, both before and after the therapy, on the Edmonton Symptom Assessment Scale, which nurses document in the electronic medical record. “They rate symptoms like anxiety, nausea, and fatigue on a scale of 1 to 10,” said Melissa Trolene, BSN, RN, CMSRN, of Silverstein 11. Kristiniak said that, based on patient self-reports, aromatherapy has decreased nausea and lessened anxiety. But their reactions to the therapy tell the real story.
Rachel Mcfadden, BSN, of Silverstein 11 described a Filipino patient who was suffering from liver failure and experiencing a great deal of pain and nausea. “Unfortunately for our patients with compromised livers, the medications that most effectively treat these maladies are either off the table or only safe in very small doses,” she said. During a bout of nausea, she offered the patient one of the ginger sniffers. “She smiled as she told me that ginger was a staple of Filipino cooking and she loved the smell.”
While it wasn't a cure, it did bring this patient some comfort . “I think this moment really captures the essence of aromatherapy -- it’s an effective intervention because of the neurochemical pathways our olfactory sense stimulates, but the memories and feelings of comfort and pleasure triggered by our sense of smell run much deeper than the physiology.”
Transplant recipients often suffer from anxiety, pain, and nausea due to frequent complications. In tandem with pharmacologic treatment, Tom Shluger, RN, BS, BSN, of Silverstein 11, offered a patient who was hospitalized for lung transplant rejection both ginger and lavender essential oil inhalers. “She was so happy to have a new tool to help calm her nerves and her stomach that didn't come with any side effects and didn't involve adding on another medication,” he said. “She used both oils many times throughout the days I cared for her. It felt great to be able to empower her to take control of that part of her treatment.”