Aromatherapy is the use of inhaled essential oils to improve health and overall well-being. This is not a new practice, in fact, essential oils were used dating back to about 5,000 years ago in ancient Egypt. Even Florence Nightingale applied lavender to wounded soldiers during the Crimean War.

An increasing focus on integrative health is prompting a resurgence in the use of essential oils for personal use, as well as in acute care settings. The care we provide in acute care focuses on easing patients’ experiences during illness or injury. As holistic providers, if the evidence shows that essential oils can play a role, it makes sense that we educate ourselves so we can provide the best patient experience and improve outcomes.

What are essential oils?

Essential oils are extracted from the stems, leaves, bark, flowers, roots, seeds, resins, or peels of aromatic plants. Their therapeutic actions and effectiveness depend on the chemical substances within the plant, the method used to obtain them and where the plants were grown (Perkins, 2020). When considering essential oils, remember that aromatherapy blends, or combining different oils together, can be considered for a complementary effect.

After inhalation, physiologic effects have been documented; it is not just the perception of the aroma. Olfactory pathways closely associated with the brain’s limbic system are affected, influencing heart rate, blood pressure, respiratory rate, memory, and hormone levels (Allard & Katseres, 2016).

When should aromatherapy be considered?

Pain

As a complementary intervention in pain management, studies show that aromatherapy seems to have beneficial effects on pain severity, and positively influences mood and quality of life (Starkweather, 2018). In their systematic review and meta-analysis, Lakhan et al. (2016) reported a significant positive effect of aromatherapy on reducing pain severity, most consistently with postoperative pain and obstetric and gynecologic pain. In the literature, lavender aromatherapy has been shown to have both analgesic and anti-inflammatory effects, making it an option to help manage pain (Silva et al., 2015; Kim et al, 2007; Starkweather, 2018).

Anxiety

Several studies looked at the use of aromatherapy to decrease anxiety in the perioperative period. Braden et al. (2009) looked at the use of olfactory and topical lavandin, and using the vertical visual analog scale (VAS), reported significantly lower anxiety at the time of transfer into the operating room. In 2016, a randomized trial provided evidence that aromatherapy using Satureja (savory), alone or concomitantly with mindfulness meditation, could reduce general anxiety levels (Soto-Vasquez & Alvarado-Garcia, 2017). One review documented effectiveness of Lavandula, Rosa damascena, Citrus aurantium Duh, peppermint, Valeriana officinalis, and Matricaria chamomilla in reducing anxiety before surgery (Abed et al., 2020). Another study revealed that the use of lavender oil on patients undergoing hemodialysis decreased fatigue and anxiety levels (Karadag & Samancioglu Baglama, 2019).

Nausea

Research supports the use of essential oils for managing postoperative nausea and vomiting, as well as other gastrointestinal issues, such as dyspepsia and irritable bowel syndrome. Hunt et al. (2013) conducted a randomized trial of aromatherapy with patients who reported nausea in the postanesthesia care unit at one ambulatory surgical center and found significant changes in nausea level and request for antiemetic medications in the group who received aromatherapy with ginger or blend aromatherapy.  Karaman et al. (2019) compared the effects of ginger, lavender and rose oils on postoperative nausea and vomiting, and concluded that ginger and lavender were superior to rose oil and pure water.

What do nurses need to know?

Only those with knowledge of safety, clinical protocols, appropriate product selection and administration should use essential oils. There are educational programs for nurses and other health care providers, and some provide continuing education hours and/or certification.

Assessing patients’ use of essential oils should be part of the conversation while taking health histories. Many patients don’t disclose use of complementary or alternative therapies unless asked. Some essential oils can potentially interact with medications, so it’s very important to integrate related questions into this part of your assessment.

Here are some more key points to keep in mind:

• Tinctures and essential oils aren’t the same. Tinctures are made with alcohol as the solvent, and are typically given orally or sublingually, and are less concentrated than essential oils (Perkins, 2020).
• Essential oils should never be applied undiluted, with the exception of lavender and tea tree oil (Perkins, 2020).
• Make sure patients know that essential oils should be applied topically or diffused into the air; they should not be taken orally unless under the supervision of a healthcare provider (Perkins, 2020).

Best Practices

• A well-developed protocol is essential to support safe and sustainable use of essential oils in the hospital setting (Allard & Katseres, 2016).
• Use only therapeutic grade essential oils (Perkins, 2020). Since essential oils are not regulated by the FDA, it is the responsibility of the facility or practitioner to ensure the quality of products (Allard & Katseres, 2016).
• Assess patients for allergies and sensitivities (Perkins, 2020).
• Encourage patients to ask questions and provide evidence-based answers and information.
• Ensure essential oils are stored appropriately to minimize degradation.
• Follow your facility’s policy regarding single-use products to prevent infection.
• Include use of aromatherapy in your documentation, including the use of scales to evaluate effectiveness (i.e., pain scales or nausea scales).

Research has shown the benefits of aromatherapy for certain indications in the acute care setting. In general, its use is well tolerated and inexpensive, and can lead to decreased use of pharmacologic agents. As with any intervention, it’s important to be well-educated in the use of aromatherapy before administering any essential oils.

Please explore the references and additional resources below for more information. Also, leave a comment to share your experiences – let’s learn from each other!
 

References:

Ebrahimi, A., Eslami, J., Darvishi, I., Momeni, K., & Akbarzadeh, M. (2020). Investigation of the Role of Complementary Medicine on Anxiety of Patients Before and After Surgery: A Review Study. Holistic Nursing Practice, 34(6), 365–379. https://doi.org/10.1097/HNP.0000000000000414

Allard, M. E., & Katseres, J. (2016). Using Essential Oils to Enhance Nursing Practice and for Self-Care. The American Journal of Nursing, 116(2), 42–51. https://doi.org/10.1097/01.NAJ.0000480495.18104.db

Braden, R., Reichow, S., & Halm, M. A. (2009). The use of the essential oil lavandin to reduce preoperative anxiety in surgical patients. Journal of Perianesthesia Nursing: Official Journal of the American Society of Perianesthesia Nurses, 24(6), 348–355. https://doi.org/10.1016/j.jopan.2009.10.002   

Childers, P. M., & Aleshire, M. E. (2020). Use of Essential Oils by Health Care Professionals for Health Maintenance. Holistic Nursing Practice, 34(2), 91–102. https://doi.org/10.1097/HNP.0000000000000367

Cho, E. H., Lee, M. Y., & Hur, M. H. (2017). The Effects of Aromatherapy on Intensive Care Unit Patients' Stress and Sleep Quality: A Nonrandomised Controlled Trial. Evidence-Based Complementary and Alternative Medicine: eCAM, 2017, 2856592. https://doi.org/10.1155/2017/2856592

Ebrahimi, A., Eslami, J., Darvishi, I., Momeni, K., & Akbarzadeh, M. (2020). Investigation of the Role of Complementary Medicine on Anxiety of Patients Before and After Surgery: A Review Study. Holistic nursing practice, 34(6), 365–379. https://doi.org/10.1097/HNP.0000000000000414

Hunt, R., Dienemann, J., Norton, H. J., Hartley, W., Hudgens, A., Stern, T., & Divine, G. (2013). Aromatherapy as treatment for postoperative nausea: a randomized trial. Anesthesia and Analgesia, 117(3), 597–604. https://doi.org/10.1213/ANE.0b013e31824a0b1c

Karadag, E., & Samancioglu Baglama, S. (2019). The Effect of Aromatherapy on Fatigue and Anxiety in Patients Undergoing Hemodialysis Treatment: A Randomized Controlled Study. Holistic Nursing Practice, 33(4), 222–229. https://doi.org/10.1097/HNP.0000000000000334

Karaman, S., Karaman, T., Tapar, H., Dogru, S., & Suren, M. (2019). A randomized placebo-controlled study of aromatherapy for the treatment of postoperative nausea and vomiting. Complementary therapies in medicine, 42, 417–421. https://doi.org/10.1016/j.ctim.2018.12.019

Kim, J. T., Ren, C. J., Fielding, G. A., Pitti, A., Kasumi, T., Wajda, M., Lebovits, A., & Bekker, A. (2007). Treatment with lavender aromatherapy in the post-anesthesia care unit reduces opioid requirements of morbidly obese patients undergoing laparoscopic adjustable gastric banding. Obesity Surgery, 17(7), 920–925. https://doi.org/10.1007/s11695-007-9170-7

Knoerr K. (2018). Essential Oils: An Adjunct to Holistic Nursing. Gastroenterology Nursing: The Official Journal of The Society of Gastroenterology Nurses and Associates, 41(3), 250–254. https://doi.org/10.1097/SGA.0000000000000360

Lakhan, S., Sheafer, H., & Tepper, D. (2016). The Effectiveness of Aromatherapy in Reducing Pain: A Systematic Review and Meta-Analysis. Hindawi Publishing Corporation Pain Research and Treatment, 8158693. http://dx.doi.org/10.1155/2016/8158693

Meghani, N., Tracy, M. F., Hadidi, N. N., & Lindquist, R. (2017). Part II: The Effects of Aromatherapy and Guided Imagery for the Symptom Management of Anxiety, Pain, and Insomnia in Critically Ill Patients: An Integrative Review of Current Literature. Dimensions of critical care nursing : DCCN, 36(6), 334–348. https://doi.org/10.1097/DCC.0000000000000272

O'Malley P. A. (2016). Aromatherapy for Postoperative Nausea in Acute Care-Evidence and Future Opportunities. Clinical Nurse Specialist, 30(6), 318–320. https://doi.org/10.1097/NUR.0000000000000254

Perkins. A. (2020). Have you considered aromatherapy? Nursing Made Incredibly Easy!, 18(6), 20–24. https://www.doi.org/10.1097/01.NME.0000717688.95931.da  

Silva, G. L., Luft, C., Lunardelli, A., Amaral, R. H., Melo, D. A., Donadio, M. V., Nunes, F. B., de Azambuja, M. S., Santana, J. C., Moraes, C. M., Mello, R. O., Cassel, E., Pereira, M. A., & de Oliveira, J. R. (2015). Antioxidant, analgesic and anti-inflammatory effects of lavender essential oil. Anais da Academia Brasileira de Ciencias, 87(2 Suppl), 1397–1408. https://doi.org/10.1590/0001-3765201520150056

Soto-Vásquez, M. R., & Alvarado-García, P. A. (2016). Aromatherapy with two essential oils from Satureja genre and mindfulness meditation to reduce anxiety in humans. Journal of Traditional and Complementary Medicine, 7(1), 121–125. https://doi.org/10.1016/j.jtcme.2016.06.003

Starkweather, A. (2018). Aromatherapy: Does It Make “Scents” as Complementary Therapy in Pain Management? Topics in Pain Management, 34(1), 1–8. https://www.doi.org/10.1097/01.TPM.0000544120.47075.8e

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The Effects of Inhalational Lavender Essential Oil Aromatherapy on Sleep Quality in Hemodialysis Patients: A Before-and-After-Intervention Trial	The Impact of Postoperative Patient Aromatherapy on Nurse Self-Efficacy	Nurse-led strategies to decrease preoperative patient anxiety