Aromatherapy: the challenges for community nurses

Author(s): Tzu-I Chiu

Key words:
Alternative therapies
Essential oils
Complementary medicine

Tzu-I Chiu discusses the use of aromatherapy in nursing care

Tzu-I Chiu PhD, RN is Assistant Professor Central Taiwan University of Science and Technology

Article accepted for publication: January 2009

Health and recovery from illness is a multi-factorial phenomenon. Conventional medicine primarily addresses the physical
needs of an individual, whilst on the other hand, complementary care aims to assist in the delivery of holistic care by using a range of
therapies that complement conventional care (Dunning & James, 2001). Holistic care is often described as one addressing physical,
psychological, spiritual and social needs and the utilisation of complementary and alternative medicine (CAM) is increasing in both
the public and health professional fields such as nursing.

The International Council of Nursing define nursing as “encompasses autonomous and collaborative care of individuals of
all ages, families, groups and communities, sick or well and in all settings.” (International Council of Nursing, 2007).

Nursing, therefore, is a unique profession concerned with all variables affecting clients in their environment. The professional nurse
uses knowledge from the physical, biological, and social sciences as a basis for understanding health and illness. And aims to treat
and care for that whole person not only the illness.

The use of CAM is based on a long history of traditional use, anecdotes and case reports. There is a growing number of
population in the world are using alternative approaches to health promotion, and medical treatment.

From those complementary and alternative approaches, aromatherapy is one of the fast growing therapies for those populations. The
purpose of this study is to discuss the use of aromatherapy in nursing profession and the challenge of aromatherapy in the future.

Aromatherapy

Aromatherapy is the therapeutic use of essential oil that are derived from plants, flowers, leaves, barks,
seeds, roots, resins, stems and fruits, and extracted commonly by a process of distillation with the intent to
calm, balance, and rejuvenate mind, body, and spirit (Wheeler-Robin, 1999). There are many different ways of
using essential oils therapeutically - in baths, inhalations, compresses, creams or lotions, relaxing and the
therapeutic way- through aromatherapy massage. There are also several therapeutic components of an
aromatherapy massage that include touch, the pharmacological actions of essential oils on physical,
psychological and spiritual levels and, frequently, the use of music (King, 1994).

Essential oils are attributed with the ability to promote positive emotional balance and specific physical
action. Some essential oils also have a counter-irritant effect and the combination of aromatherapy and massage
is a powerful healing combination that works on physical, spiritual and psychological levels (Dunning & James,
2001). However, Meyer (1996) states that aromatherapy is a modality which can enhance patient wellbeing by
working alongside orthodox medicine in a complementary manner, offering support in quality of life and
symptomatic relief, but not claiming to cure any condition.
 Since the foundation of the International Federation of Professional Aromatherapists in 1987,
practitioners have been re-evaluating their roles as therapists. Aromatherapists continue to be labelled as “new
age” rather than “complementary” therapists and are often ignored by orthodox medicine (Lemon, 2002).
Aromatherapy and massage are very popular modalities, particularly in aged care and palliative care setting,
however, the exact number of nurses using aromatherapy in patient care is difficult to determine, but published
research suggests that nurses make up a large proportion of people undertaking complementary therapy to
patients’ care, especially aromatherapy.

The challenge of aromatherapy

When reviewing research, sample size is often commented on, with small samples sometimes sufficing
to discredit a study. However, Polgar and Thomas (1995) stated that only a few subjects are ethically necessary
in some of health-related studies. In addition, published research on aromatherapy tends to be anecdotal rather
than clinical, and a lack of funding for clinical aromatherapists has made it difficult to set up trials (Lemon,
2002). However, the situation is changing and the Research Council for Complementary Medicine collates
published research in the field. Tisserand and Balacs (1995) carried out extensive research on the safety of
essential oils, and Price and Price (1999) discuss how aromatherapy works specifically for health care
professionals. Clinical research exists and has been published in areas where it is likely to come to attention of
mainstream health care professionals and budget-holders.

The National Center for Complementary and Alternative Medicine (NCCAM), is the United States
Federal Government’s lead agency for scientific research on complementary and alternative medicine. NCCAM
is a group of diverse medical and health care systems, practices, and products that are not presently considered
to be part of conventional medicine and its mission is to explore complementary and alternative healing
practices in the context of rigorous science, to train CAM researchers and to inform the public and health
professionals about the results of CAM research studies (NCCAM, 2007).

In the UK, The Prince of Wales’s Foundation has funded a total of £900,000 for integrated health since
2005. This funding is mainly to support the Foundation’s work in developing robust systems of regulation for
the complementary healthcare professions (DH, 2004). In addition, in response to the UK population increasing
their interest in, and use of, complementary and alternative medicine, there are numbers of regulations regarding
to CAM. For instance, individuals in the UK who wish to practice as chiropractor must register with the General
Chiropractic Council. (DH, 2007).

Essential oils

There are various types of essential oil for aromatherapy professionals to choose for their clients’ care.
Different types of essential oil have different results and have their own characteristics. Lavender and rosemary
for instance are two of the most popular essential oils used by aromatherapy professionals and nursing
researchers.

Lavender: Lavender is part of the Labiatae family. It is cultivated widely all over the world. Lavender is
the most popular and it has been shown to reduce anxiety (Burnett et al., 2004; Rho et al., 2006. Moss et al.
(2003) studied the impact of lavender and rosemary on cognitive performance and mood in healthy volunteers.
They found that lavender produced a significant decrement in performance of working memory. Itai et al.
(2000) study also showed lavender significantly decreased the mean scores of the Hamilton rating scale for
depression (HAMD) in patients who were being treated with chronic haemodialysis. Lewith et al. (2005)
evaluated the efficacy of lavender on insomnia and result showed lavender improved the sleep quality by using
Pittsburgh Sleep Quality Index (PSQI). Diego et al. (1998) used two essential oil (lavender & rosemary) and
tried to find the effect they had on mood, EEG patterns of alertness and math computations. The results showed
participants that were in lavender group increased beta power that suggested increasing drowsiness, participants
had less depressed mood and reported feeling more relaxed. In addition, participants performed the
mathematical computations faster and more accurately following aromatherapy with lavender essential oil.

Rosemary: Rosemary essential oil is popular oil in aromatherapy as it revives, warms, stimulates and
restores and is often used in aromatherapy research. Moss et al. (2003) showed rosemary produced a significant
enhancement of performance for overall quality of memory. Burnett et al. (2004) showed that the rosemary
scent was associated with lower fatigue. Diego et al. (1998) study indicated rosemary decreased frontal alpha
and beta power that suggested increasing alertness. The participants had lower state anxiety scores and reported
feeling more relaxed and alert. The participants, however, were only faster, not more accurate when they
performed the math computations after the aromatherapy with rosemary essential oil.

Research continues to validate the use of aromatherapy in a number of ways and despite the limited
scientific research into the therapeutic effects of aromatherapy, there are positive psychological and physical
results in the studies.

Training
 The quality of complementary therapy training in many countries varies widely despite the many
courses available, and nurses claim that many complementary therapies are inherent in nursing practices. There
are legitimate concerns about the safety and efficacy of complementary therapies as some have more potential
for harm than others. The essential oils are complex chemical compounds and the professional practitioner
should be avoid or used essential oils with serious caution in some conditions such as pregnancy and allergic
sensitivity. A number of complementary therapy experts have cited that the potential dangers of aromatherapy
are rising due to its use by untrained staff with respect to patient safety (Buckle, 1997; Pfeil, 1994). Dunning
and James (2001) investigated the use of aromatherapy on hand and foot massage in a rural rehabilitation
setting. An education programme for nurses and family members was developed and implemented. They found
that patients had a significant reduction in pain and anxiety after the treatment. They also found that nurses felt
confident to deliver the aromatherapy massages, but the non nursing participants would have liked more
practice before they entered the clinical setting.

In general, the harm of CAM may result from the therapy itself; occur as a result of not consulting
orthodox care soon enough, incorrect diagnosis, or as a result of insufficient knowledge and competence of the
people delivering the therapy. Therefore, educating practitioners and monitoring outcomes are important
elements of safety. In addition, outcome monitoring can contribute to the evidence base of complementary
therapy practice and although overall aromatherapy therapies comprise only a small part of nursing practice,
their usage in increasing, and in the authors opinion there is a need to provide education opportunities to nursing
professionals to open their mind and help them discover whole new ways of healing and caring for patients.