The effect of aromatherapy in promoting relaxation and stress reduction in a general hospital

Graham Cannard
The Tullamore Nursing Development Unit (NDU), since its inception in 1993, has been engaged in improving the quality of nursing practice offered to the patients in the N D U and in the hospital as a whole. Many areas of patient care have been addressed, including some of the more tenacious problems, which have often proved resistant to traditional nursing care. One such problem is sleep disturbance, especially in the older patient. In order to try to improve the care available, the staff of the N D U have had to adopt some alternatives to the traditional way of thinking. The use of aromatherapy has significantly improved the sleep patterns of the patients and at the same time, reduced the amount of night sedation required. Following a study of the effectiveness of aromatherapy, it is now being successfully used in the Coronary Care Unit for patients with problems of stress, with encouraging results.

One of the more tenacious problems that the NDU staff have tried to deal with is that of sleep disturbance in the older patient.

INTRODUCTION
The Tullamore Nursing Development Unit (NDU) in the General Hospital, Tullamore, Co. Offaly, Republic of Ireland was started in 1993. Probably the most important aim of the NDU is to improve the quality of nursing care on offer to the patients. Thi3 may involve adapting existing nursing practices to more accurately meet the needs of the patients and their families, or in certain instances, the introduction of completely new practices in order to meet needs that had previously been unidentified or inadequately met by traditional nursing practice. One of the more tenacious problems that the NDU staff have tried to deal with is that of sleep disturbance in the older patient. Many of the usual nursing practices, whilst helpful to some degree, often do not make a significant enough difference to the patients' sleep pattern to be considered successful. Night sedation in the form of medication is often prescribed for patients with sleep difficulties, but this is not usually appropriate for long-term use and may in fact be contra-indicated if it causes a 'hangover' effect. This can predispose to other problems in itself such as drowsiness and falls. It was decided that alternatives to the accepted

nursing repertoire were required, and that all viable options would be considered. With the recent revival of interest in complementary therapies, especially in the UK, it was decided that some form of complementary therapy may provide an answer to the problem, or at least to help ameliorate the situation. The use of complementary therapies in nursing, in Ireland, is still very much in its infancy, and therefore, information on the subject came mainly from the UK. From this, an interest in aromatherapy developed among the staff as it appeared to be a plausible therapy to the newcomer and ideally suited to the problem of sleep disturbance, in that it aims to 'normalize' the body systems. In addition, the availability of a professionally qualified aromatherapist, who is also a Registered General Nurse, influenced the decision. It was recognized that thorough educational preparation of the NDU staff was of paramount importance with regard to efficacy and safety. This is especially so in a hospital setting (Mackereth 1995).

Graham Cannard RGN, Coordinator, Nursing Development Unit, General Hospital,

Arden Road, Tullamore, Co. Offaly, Eire. Tel: +353 506 21501; Fax: +353 506 51204

EDUCATIONAL

PREPARATION

A nurse-aromatherapist was enlisted to visit the NDU and help to educate and prepare the nursing

Complementary Therapies in Nursing and Midwifery (I 996) 2, 38~10 9 1996PearsonProfessionalLtd

The effect of aromatherapy in promoting relaxation and stress reduction in a general hospital

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The results of the study showed that the particular blend of oils, when used as described, was effective in improving the sleep patterns of the patients.

staff to administer aromatherapy. Because of the vast array of essential oils available, expert advice was given on the best oils to use. It was suggested that a commercially pre-mixed synergistic blend of oils would be advisable as there could not then be any error with the mixing of oils. The blend selected by the aromatherapist was one of essential oils of basil (Ocimum basilicum), juniper (Juniperus communis), lavender (lavandula angustifolia), and sweet marjoram (origanum marjorana). All NDU nurses were trained in the administration of this blend by inhalation, and when mixed with sweet almond oil as a carrier, by hand massage. Prior to the commencement of this therapy, the staff undertook practical and theoretical training in the use of this blend with people with sleep disturbance. No other oils were used (or were available) and no other patient problems were treated with aromatherapy at that time. The consultant physician managing the medical care of the patients in the NDU was informed of the intention to use aromatherapy to help improve the sleep patterns of the patients, and was fully supportive of the project (Cannard 1995). In accordance with the Kings Fund Nursing Developments Network criteria for NDUs, evaluation of the effectiveness of the project was undertaken.

RESULTS
The results of the study showed that the particular blend of oils, when used as described, was effective in improving the sleep patterns of the patients. The number of patient nights in which a refreshing night's sleep was achieved was 73% prior to the use of aromatherapy, but this improved to 97% with the use of the oils. At the same time, the requirement for night sedation was reduced from 90% to 36% of patient nights when using the oils.

LIMITATIONS
The study was limited by the small sample size (n= 10), and the fact that only one particular blend of oils was used. It may be that different oils may have been more effective for some of the patients, but due to safety precautions, these could not be used. Another limitation is that where aromatherapy hand massage was used, no evaluation of the effectiveness of a plain hand massage was undertaken. It could be questioned as to whether it was the massage itself, rather than the oils used in the massage that was effective.

METHODS
The study consisted of recording the sleep patterns of the patients in the NDU over a two-week period prior to the use of aromatherapy, and again following the introduction of aromatherapy. In all, data was gathered for 94 patient nights before aromatherapy and 94 patient nights afterwards. Data was gathered by a registered nurse at the end of each night shift. The data was entered onto a form which gave information on the oil used, route of administration, any night sedation given and whether the patient stated that they had had a restful night's sleep. Only patients who were present before and after the introduction of aromatherapy were included in the study. Each patient had data entered for the same number of nights both prior to, and after the introduction of aromatherapy. The method of administration of the oils was that each patient was given one drop of the blend on each of the top comers of the mattress when retiring for the night. This provided a safe method of inhalation as the oil did not come into contact with the patients' eyes or mouths. Where inhalation alone was not effective after one or two hours, a five minute hand massage using the blend of oils in a sweet almond carrier oil was employed. If the patient was still awake at midnight, and this was causing distress, prescribed night sedation was offered (Cannard 1995).

DISCUSSION
Whilst little research has been carried out into the effectiveness of aromatherapy, considering its growing popularity (Stevensen 1994), at least one other study was undertaken into the use of aromatherapy with sleep disturbances, and this study also concluded that it is effective (Hardy 1991). One of the limitations of this study was that it included a sample of only four patients. The results obtained from such a sample may not be indicative of the general response. The positive effect that the use of aromatherapy had on the patients in the NDU, prompted huge interest among the nursing staff and others in the hospital. Many requests for information were received, some from medical staff, but mostly from nurses from both within this hospital and outside. Particular interest was shown by the Coronary Care Unit (CCU) staff, who wanted to investigate the possibility of using aromatherapy to help reduce stress levels in coronary patients. Stress and anxiety are recognized as significant predisposing factors in causing coronary problems, and can hamper the recovery of those patients who have suffered a cardiac insult, so any method of reducing stress and anxiety levels was considered worthy of investigation. Complementary therapies, because of their holistic mode of action, can help the patient to put themselves in

... the requirement for night sedation was reduced from 90% to 36% of patient nights when using the oils.

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CONCLUSION
In both the NDU and the CCU, patients and visitors have reported a calm and relaxed atmosphere. This is an intentional effect brought about by many factors working in harmony, however, since the introduction of aromatherapy, patient and visitor comments have become noticeably more marked. The value with which the patients regard the use of essential oils as part of their care is shown by the large number who request information to enable them to continue use at home following discharge. Patients who have experienced aromatherapy in the two units have reported its beneficial effects in aiding relaxation and reducing stress and anxiety. Sleep patterns have also improved dramatically for those patients who had previously experienced sleep difficulties. The relatives of the patients, and the staff can also see the effect. Aromatherapy has added another dimension to the established nursing repertoire in these units to help address some difficult and tenacious problems, and this complementary therapy is not now seen as an alternative therapy, but as an additional one.

The outcome of aromatherapy in the CCU has been a significant reduction in patients' anxiety and stress levels.

Aromatherapy has added another dimension to the established nursing repertoire...

a better position for self healing (Wright 1995), and when used to help the patient relax, can greatly reduce one of the risk factors for coronary problems. In the four-bedded CCU, advice was sought from the nurse-aromatherapist, who again recommended the use of a pre-mixed blend of essential oils designed to reduce stress. The blend was of essential oils of basil, juniper, lavender and sandalwood. The blend of oils was vaporized into the atmosphere by the use of electric vaporizers, and these have been left switched on 24 hours a day for over a year. The sleep blend was vaporized at night and the stress blend was used during the day. No adverse effects have been reported by patients or staff, to date. If adverse reactions occur, the oils will be administered by placing two drops at the head of each participating patient's mattress, rather than by vaporization into the atmosphere. In conjunction with the use of aromatherapy, advice on other, more conventional, methods of reducing stress was given to the patients as part of their formal cardiac rehabilitation programme. The use of non-verbal relaxation music tapes was offered along with aromatherapy, and specific relaxation periods were set aside during the day. The outcome of aromatherapy in the CCU has been a significant reduction in patients' anxiety and stress levels. This was reflected in the reduction of anxiolytic medication found necessary by approximately 50%. Accurate figures were not available at this time as detailed evaluation has not yet been undertaken. When formal evaluation is undertaken, the effect of Aromatherapy will have to be isolated from the effects of the other stress reduction techniques.

REFERENCES
CannardG 1995 On the scentof a good night's sleep. Nursing Standard 9: 34; 21 Hardy M 1991 Sweet scenteddreams. InternationalJournalof Aromatherapy 1991 3(1): 11-13 Mackereth P 1995 Aromatherapy,nice but not 'essential'. ComplementaryTherapies in Nursingand Midwifery 1: 4-7 StevensenC J 1994The psychophysiologicaleffects of aromatherapy massagefollowingcardiac surgery. ComplementaryTherapiesin Medicine2:27-35 Wright S G 1985Bringingthe heartback intonursing.ComplementaryTherapiesin Nursingand Midwifery 1:15-20