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Soothing “Sniffers” and Holistic Healing

“How to Keep Fat Burning Post-Workout.” “Your Clean Eating Grocery List.” “25 Essential Oil Remedies for Every Ailment.” In the (paraphrased) words of Sesame Street, one of these articles is not like the others...or is it? Whether you’re paging through health magazines or scrolling through motivational Pinterest boards, you’re likely to find that the focus on mind and body wellness doesn’t end at 30-day exercise challenges, detox nutrition guides, and a few yoga poses and mindfulness tips. From testimonials about homeopathic remedies and acupuncture recommendations, to recipes for herbal balms, salves, and teas, alternative and complementary therapies have escaped the fringes and experienced a surge in popularity that has extended off the page and into the healthcare field.

As a disclaimer, it’s of course important to note that using “alternative” medical approaches in place of conventional medicine can be extremely risky, often providing only a placebo effect, but even causing further harm. Sure, a brightly colored photo of a calm woman serenely pounding away at some herbs with a mortar and pestle may be perceived as more natural than an image of pills being manufactured by a pharmaceutical company – an image some associate negatively with medical “invasiveness” or “foreignness.” No matter how appealing the marketing, though, perception is not necessarily reality, and many alternative remedies are not regulated by the federal government in the same way that prescription drugs are. Even “complementary” or “integrative” therapies, which are used in conjunction with Western medicine and are commonly used to provide symptom relief, can have dangerous side effects if combined incorrectly with the primary treatment.

However, while approaches like crystal healing fall in the realm of pseudoscience and aren’t likely to be integrated into a healthcare program any time soon, other complementary therapies, such as aromatherapy, have made their way into hospitals as legitimate pain and anxiety management methods, including at Pennsylvania Hospital (PAH) and the Hospital of the University of Pennsylvania (HUP).

Heather Cochran, RN, explains the aromatherapy process to her mock patient, Carrie Marvill, MSN, RN, AOCNS.

For as long as botanicals have been utilized cosmetically, their medicinal qualities have also been used to treat a wide range of ailments – we’re talking millennia here. Aromatherapy is thought to work by stimulating the smell receptors in the nose, which then send messages through the nervous system to the limbic system – the emotion center of the brain – which help to promote a sense of physical and psychological well-being. Whether inhaled, applied to the skin, or simply diffused through a room, aromatic essential oils have earned a reputation for reducing stress, soothing soreness, improving sleep quality, and more.

When nurse manager Bonita Ball, MSN, RN, NE-BC, CCRN-K, began considering how to work a holistic approach into a new quality improvement program, integrating aromatherapy into her unit seemed like an exciting new direction with measurable results and without any of the pitfalls of more “mystical” therapies. Under the direction of the Nursing Executive Board and the Pain Resource Nurse Committee, and with the guidance of Susan Kristiniak, DHA, MSN, the health system’s associate director of Palliative Care and the driving force behind HUP’s aromatherapy program, Ball designed a program outline that would help her team combine the conventional with the complementary.

“The beauty of integrative therapy is that it provides the patients with more tools for their wellness toolkit, so to speak. It gives them a wider range of options to alleviate their discomfort,” said Kristiniak. “In response to the opioid epidemic, the Joint Commission has been promoting non-pharmacological options for pain management. Starting in 2018, hospitals will be scored based on their non-pharmacological strategies, and aromatherapy definitely qualifies. Penn Medicine is already in line with the new guidelines, and we've truly embraced the concept of expanding our treatment options to ensure our patients have a more comfortable experience.”

Despite even the Joint Commission’s emphasis on integrating new treatment options and adjusting what qualifies as standard, the terms “complementary” and “integrative” medicine can still prompt some leery reactions. However, when Ball introduced her program idea during a staff huddle, she was thrilled to find that she had “100 percent buy-in from everyone on the team, which was key.”  With her team’s enthusiasm in mind, Ball collaborated with Kristiniak to develop a two-hour, competency-based education program in alignment with the protocols already established at HUP.

“I’m excited to say that all of our Hematology/Oncology employees have been trained – whether they’re a nurse or a patient care tech,” Ball said. “The main barrier to integrative therapies is a lack of knowledge, so after the two-hour training with Susan, there is also a level of in-house training. This ensures that when our staff members sit down with a patient to talk about the program, they can go answer any questions confidently and accurately.”

Ball’s team oversees a range of patients, but PAH’s pilot program is initially geared specifically toward Hematology/Oncology patients receiving chemotherapy. Because chemotherapy often induces nausea, and frequent hospital visits for serious diagnoses can stoke fears, starting with this patient population offers the chance to measure the effectiveness of aromatherapy as a way to ameliorate some of the unpleasant effects of conventional cancer treatments. Three highly concentrated essential oil scents were chosen for their relevance to the needs of this patient group: lavender, which can soothe anxiety and promote relaxation, and ginger and peppermint, both of which can settle nausea. No amount of aromatherapy will cure cancer or any other illness, but as a complementary therapy, it can certainly help patients cope with the side effects of their main treatment and experience a better quality of life.

Before offering the “sniffers” to a patient – lip-balm sized tubes in each of the three scents – a nurse first performs an assessment to determine whether there are any possible allergies, sensitivities, or cardiac issues that could cause complications. The nurse also needs to carefully go through the aromatherapy brochure with the patient so they are aware of the extent of the therapy. If the patient is cleared and is interested in participating, they receive their sniffers in a small bag they can keep by their bedside and take home with them between treatments. The bags, which have a six-month shelf life, are sealed and dated by the staff. The sniffers are easy to use without supervision, but patients are encouraged to use them in front of staff so the effects of the program can continue to be monitored and recorded.

At a recent meeting of Pennsylvania Hospital’s service directors, Ball and Lauren Ellis, MSN, RN, CEN, presented the early results of the pilot program. They noted that during the trial period, 98 Hematology/Oncology patients met the requirements to participate in the aromatherapy program, and 66 eligible patients ultimately took part. Of the participants, 50 (75 percent) experienced a noticeable sense of relief from nausea and/or anxiety after using the sniffers, while the remaining 16 reported that they felt no difference. None experienced a negative reaction.

Tyrell Lewis-Jones, a patient care technician, demonstrates the calming lavender hand massage.

The aromatherapy program also includes another feature: a lavender hand massage, which combines aromatherapy with gentle massage therapy. As with the sniffers, patients must first be evaluated by a nurse before they can elect to participate. If permitted, a calming hand massage performed by a patient care tech is theirs to enjoy. One patient, who has enjoyed both aromatherapy programs, is a particular fan of the hand massage because the smell of the lavender does not fade for a while. This allows her to continuously experience a sense of relief as she eats or touches her face throughout the day. For her, the only improvement would be if the massage extended to her feet and back!

“I practice yoga regularly, and as someone with an in-depth understanding of pressure points, the hand massage is so helpful,” she said. “Having pressure applied to certain points can be so soothing. I could feel the relief wash from those spots all the way down to my legs, and the smell sticks around. It feels like the days move more quickly when I get to use the aromatherapy.”

The early successes of the program have sparked Ball to propose the expansion of the aromatherapy program to additional patient groups in the near future, including to new mothers and to those with sickle cell anemia. Ultimately, the goal is to build off the resounding success of HUP’s fledgling program and to offer aromatherapy (and perhaps additional programs like Reiki) across Pennsylvania Hospital and throughout the rest of health system. As more data is collected and more staff and patients are exposed to the possibilities of complementary therapies, Ball hopes that a holistic healing process becomes a staple of care at Penn Medicine.

“Healing is all-inclusive. As nurses, we say that we take care of the whole patient – body, mind, and spirit,” Ball said. “It’s important for all patients throughout Pennsy and the health system that their care providers split their focus on the emotional and spiritual parts of healing, in addition to the physical. The ultimate goal of these integrative therapies is to supplement their treatment and give a better overall experience.”

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Views expressed are those of the author or other attributed individual and do not necessarily represent the official opinion of the related Department(s), University of Pennsylvania Health System (Penn Medicine), or the University of Pennsylvania, unless explicitly stated with the authority to do so.

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