Advancing Aromatherapy - Essay Example

Advancing Aromatherapy in the Mainstream Through Aided Research: A Proposed Evidence-Based Practice My Current Role and Personal LearningObjectives for Advancing Practice I am currently a registered nurse who works in a hospital in a regular basis. My tasks involve looking after the patient's welfare and ensuring that his needs are taken care of at all times, which is undertaken by being a patient advocate in a modern healthcare setting that is patient-focused and patient-oriented. My personal learning objectives for advancing practice involve furthering the nursing profession and establishing a scientific ground on which the delivery of healthcare services is founded. This is through an evidence-based nursing practice, which has been an outcome of both a tested experience and a systematic research. This advancing practice with aromatherapy as the subject is based on my personal learning objectives that account to using the therapy as an effective method of relaxation and battling diseases, on which the therapy is not yet fully explored, as studies show. Another personal objective in pursuing evidence-based practice in aromatherapy is scrutinizing the therapy and coming up with a leaflet that includes discussion of its nature of healing. It is hence, imperative to find a thorough scientific and systematic basis for aromatherapy in order to achieve these personal objectives. Aromatherapy is a treatment that uses pure aromatic plant oils to enhance or restore well-being through the stimulation of the body's natural healing processes (Fawcett, 1998). It refers to therapeutic use of essential oils and the volatile organic constituents of plants, which serve as common ingredients in pharmaceuticals, perfumes, and food (Buckle, 1998). Its use in nursing care continues to be popular in many settings. Currently, most of the nursing literature discusses the use of essential oils in low dosage for massage or its use as environmental fragrances, which has been popular nowadays. The wider literature offers information that adds to the evidence base for use of aromatherapy in nursing practice (Maddocks-Jennings and Wilkinson, 2004). The findings of Maddocks-Jennings and Wilkinson about the evidence use of aromatherapy in nursing care suggest that despite calls for more research in the 1980s and 1990s, there remains to be a little empirical evidence to support the use of aromatherapy in nursing practice beyond enhancing relaxation. The study indicates that the popularity of aromatherapy needs to be balanced against the potential risks pertaining to safety, allergies, and inappropriate use by inexperienced users who believe that the therapy is a safe method of healing. These findings infer of a great potential for more collaborative research by nurses in exploring the clinical applications of aromatherapy in a more substantive detail, as well as moving beyond the low dose paradigm of application of essential oils in the therapy (ibid). This reality is contributory to advancing practice in the same subject, which poses as both a challenge and responsibility on my part to focus on. The lack of research-based evidence of aromatherapy only proves the necessity to pursue research, which will serve as the basis of pursuing the therapy in my clinic. The prospects for this will initially be laid down by this paper. Literature Review It is important to determine the nature of evidence in addressing the concerns of this paper, and Upshur (2001) states that the etymology of the term is rooted in the concept of experience, relating a practice to what is manifest and obvious. In the realm of health care, the concept of evidence is interpreted in connection with the constructs of proof and rationality (Rycroft-Malone, et al., 2003). A unifying theme about the concept of evidence suggests that however it is construed, it must be observable and verifiable (Davies et al., 2000). Evidence-based practice is a systematic approach to problem solving for health care providers with an aim to provide the best possible care to patients through the best evidence currently available for clinical decision-making (Pravikoff, et al., 2005). It is important that nurses are prepared to engage in this process, and in doing so, they must have an access to tools with which to obtain evidence and the corresponding skills needed (ibid). At present, the nursing profession faces a background of financial constraints, increased managerialism research evidence, risk reduction, and research about effectiveness assumes pre-eminence (Rycroft-Malone, et al., 2003). This is so because an effective nursing practice can only be achieved though several sources of practice-based evidence. In this light, the four types of evidence possess potential contributions in the delivery of care; namely research, clinical experience, information from the local context, and patient experience (ibid). It is furthered that only when a broader definition of what counts as evidence is embraced will the delivery of effective, and evidence-based patient-centered care will be finally realized (Rycroft-Malone, et al., 2003). On the other hand, Upton (1999) suggested that there is currently a gap between theory and practice in nursing, and this poses a problem in achieving an evidence-based practice. In a study conducted among a selection of nurses in the United States, it was found out that nurses neither understand nor value research and receive a little or no training in the use of tool that would aid them in finding evidence on which practice may be based. Although they acknowledge that they need information for practice, the study suggests that they would better approach and ask colleagues or peers about these than undertake actual research (Pravikoff, et al., 2005). Aside from this, they tend to use the internet for this purpose rather than use bibliographic databases that may give them specific information (ibid). It is clear that the objective of an effective practice-based evidence for health care is in order that practitioners ensure that people receive care based on the best possible evidence (Rycroft-Malone, 2003). It is also stressed that care must be delivered according to the needs of individual patients, ensuring that such is met through effective practice-based evidence. This may be ensured if nurses and other health-care practitioners are committed to the delivery of effective care based on practice. It is imperative to mention that the principles of humanism and individualism have modified the nursing profession toward patient- centered nursing, emphasizing the centrality of the patient in the health care encounter (Rycroft-Malone, 2003). Recent literatures challenge practitioners to deliver patient-centered care based on information about what works alongside making them concerned about how evidence may be used in decision-making within the clinical context. Kitson, et al, (1998) presented a conceptual framework describing several factors that influence the uptake of evidence into practice. The framework attempts to identify the factors involved in implementing evidence-based practice, based on evidence derived from previous practice development, research projects, and quality improvement. Hence, a common assumption is surged about the concept of evidence; that it is research-based and more specifically, research evidence from the quantitative tradition (Sackett et al., 1997). It is further argued that quantitative research evidence is more highly valued than other resources in the delivery of health services (Kennedy, 2003), emphasizing its effectiveness in the health care practice. Moreover, the nursing practice is facilitated by a silent contract and relationship between a practitioner and his patient (Kitson 2002) and the crux of this relationship is complemented with the role of scientific evidence, suggesting that the nature of evidence is much broader than what people usually assume. Thus, it indicates the significant role played by experience on evidence, which must be considered along with research, in the proper delivery of effective care services. There is currently an increasing use of complementary alternative treatments by the general public, and this phenomenon makes the nurse practitioners possess the most up-to-date information about the use and safety of these modalities. Thus, a strong knowledge base of the subject will provide a sufficient and competent culturally sensitive care. However, the level of knowledge of nurses in this field remains unknown (Kitson, 2002). There is then a need to investigate the level and source of nurse practitioner knowledge of these contemporary alternative health care practices, such as aromatherapy (ibid). This is also because complementary alternative treatment has been seen as a health care practice outside the realm of dominant Western medicine. Hence, unlike the conventional Western medicine and treatment modality, complementary alternative treatments are not available in medical books as they are not widely taught in medical schools. They are also not typically utilized in modern hospitals as well as not being covered by health insurance (Kitson, 2002). Sapp (1997) used a self-designed survey instrument in which a study of 36 Missouri NPs is conducted, concerning their knowledge and practice of aromatherapy, acupuncture/acupressure, biofeedback, chiropractic, herbal therapy, massage, meditation, reflexology, therapeutic touch, and t'ai chi/yoga (energy form). Fifty-eight percent of the participants reported that they were personally utilizing complementary alternative therapies, particularly massage, meditation, and chiropractic. Sixty nine percent of the total participants claimed that they are recommending complementary alternative treatments to their patients; particularly massage therapy, meditation, biofeedback, and chiropractic treatment. More than one-half of them, however reported no knowledge of aromatherapy, herbal therapy, reflexology, and t'ai chi/yoga. Meanwhile, 42% of the 36 NPs expressed their willingness and interest to further their knowledge about CA treatment modalities (Sapp, 1997). Aromatherapy is recognized as a complementary therapy that meets the goals of both nurses and patients and is thought to work in harmony with the body, encouraging healing to take place where necessary through its balancing effect (Buckle, 1998). It aids nurses and patients toward increased comfort, relaxation, relief of pain, improved coping, and increased sense of well being (ibid). Studies show that complementary therapies tend to enhance nursing care and currently, and nurses are turning to them, such as aromatherapy. It is from aromatic plants where the essential oils used in aromatherapy are obtained. The process involves steam distilling true essential oils from the plants. A single genus of a plant can possess several species, such as the genus Thymus that includes more than 60 different species of thyme, possessing different chemistry for each, and thus, different therapeutic healing effects. It is for this reason that essential oils must be specified by the full botanical name of the plant from which they are derived. At present, there are a number of imitations of essential oils in the market used for aromatherapy, which are adulterated chemical extractions and synthetic copies, which are thought to be not suitable for clinical use. (Buckle, 1998). Aromatherapy is a gentle complementary therapy that uses smell and touch, two of the most powerful nonverbal methods of communication (Ashworth, 1984). Ashworth highlights the importance of communication with patients in critical care, commenting on the importance of the quality of human interaction to patient's mental and physical well-being, which is enhanced by aromatherapy. The introduction of aromatherapy into a critical care setting can produce far-reaching outcomes for both the patients and the staff (Stevensen, 1994). The therapeutic smell and touch brought by aromatherapy are found to have rapid therapeutic effects that can decrease stress levels, improve patients' comfort, and enhance parasympathetic responses (Shipton, 1995). This is so because essential oils contain different chemical components of molecules, which travel through the nose to the olfactory bulb and to the limbic system of the brain, an inner complex ring of brain arranged into 53 regions and 35 associated tracts (Watts, 1975). In the processing of aromas, the amygdala and the hippocampus are of particular importance among these regions (Schillmann and Siebert, 1991). The scientific basis for aromatherapy's capacity for emotional healing is explained by the amygdala, which governs emotional responses. The importance of smell in the lives of humans stems from the newborn's identification of his/her mother, and numerous studies indicate the capability of the areas of fruits and flowers in reducing depression in the elderly in residential facilities (Schillmann and Siebert, 1991). It is indeed proven that aromas contain measurable effects on many aspects of the human lives. The aromas of bergamot, chamomile, lavender, and sandalwood rose have relaxing effects while the aromas of lemon, jasmine, lemongrass, basil, and peppermint possess psychologically stimulating effects. It was also found out that the scent of citrus fruits could enhance immune function, while that of spiced apple can reduce depression and increase slow-wave electroencephalographic activity (Yoshida, et al., 1989). These significant therapeutic effects of plants on the brain were mapped with the use of computer-generated topography, which indicates how a subject psychometrically rates odors presented to the patient (Van Toller, et al., 1992). The pharmacologically active ingredients present in essential oils are found to work at physical, psychological, and cellular levels. It is also noteworthy to mention that aromas also work on learned memory, in which each person possesses a store of learned memories, including the memory of smell, unique to his/her own social, cultural, and environmental background. Thus, an aroma can trigger pleasant childhood memories, such as those that gave pleasure in childhood (i.e. newly baked bread). However, since aromas can also elicit a negative response if they are linked to an unpleasant memory, therapists should inquire about the aromas a particular patient dislikes (Buckle, 1998). Aromatherapy includes direct and indirect inhalation, in which in the former, an essential oil is directly targeted to the patient, which may be undertaken by placing 1 to 5 drops of the oil on a facial tissue, which the patient will inhale slowly and rhythmically for 5 to 10 minutes (Buckle, 1998). Infection of the lower part of the respiratory track may also be cured by 1 to 2 drops of Eucalyptus globulus (ibid). With the direct method of aromatherapy, the patient is given a constant supply of diluted essential oil along with oxygen. Infection of the upper part of the respiratory tract is treated by 1 to 5 drops of an essential oil, inhaled for 5 minutes, which can be made to float on the top of hot water in a small basin. Provided the patient is comfortable with the addition of a towel covering the head, such can add to the therapeutic value of the treatment. It is important that a nurse look after the patient for the duration of the treatment (Buckle, 1998). Aromatherapy is often used in nursing, with the use of topical applications (Tiran, 1996). It is in the form or compresses for pressure areas, contusions, and infected wounds, as well as in various kinds of therapeutic baths such as hand, foot, sitz, or full baths and in a gentle massage (ibid). The essential oil is diluted in a cream, a gel, water, or cold-pressed vegetable oil for massage or compresses. It is likewise found that gentle friction encourages absorption of the essential oils into the bloodstream through the skin (Franchomme and Penoel, 1991). A gentle strong touched, rather than a vigorous rubbing is used in the massage, in which slow stroking or gentle massage improves patients' ability to relax (Buckle, 1998). It is also found to help premature babies survive and grow as well as make pain more bearable. Simon (1976) writes, "Every human being comes into the world with the need to be touched, and the need for skin contact persists until death." The importance of touch is seen in the results of one study (Barnett, 1972) which indicates that the more critically ill a patient has become, the less he was touched. This finding suggests that patients who are more ill tend to need more the comfort of physical touch, indicating that the use of nonprocedural touch must be included into a patient's care plan. A Proposed Evidence-based Practice: Advancing Aromatherapy in the Mainstream Clinical Setting through Aided Research The increasing popularity of integrative medical care such as aromatherapy is due to the desire for more control over personal health, which includes patients' concern for holistic and balanced option for health maintenance, the high costs involved in physical and mental health care, integration of cultural practices into conventional medical arenas, and increased access to information regarding CAM therapies (Parkman, 2002). As it is apparent that patients seek the aid of CAM therapies, particularly aromatherapy more than the dominant health care therapy, its effectiveness and practicality must have suited their preferences. The catalyst toward the move from dominant health care to CAM therapies such as aromatherapy needs rethinking of staff competency, patient assessment, and patient-focused care. There is a need of restudying and reconsidering aromatherapy as an effective treatment and relaxation. These restudying and reconsidering efforts toward aromatherapy are the proposed advancing practice in this paper in terms of the nursing profession. A thorough scientific research on aromatherapy is proposed to be undertaken in this paper, in order that the dominant health care therapy may regularly integrate it to its practice. Nurses and other health care practitioners would in the same way be able to integrate an evidence-based practice of aromatherapy alongside the same interest in furthering the dominant health care practice. Research of aromatherapy involves quantitative methods, just like the need for dominant health care therapy. It must be thorough, sustained, and consistent in order that sufficient findings may be fully studied and a possibility of formally integrating it to the dominant health care therapy may be considered. There is however, no denying the fact the effectiveness of aromatherapy cannot be questioned anymore, but it is important to make patients aware of consulting a CAM therapist or a mainstream health care therapist in terms of dosage and suitability of the therapy to one's health condition. This concern is also one that research on aromatherapy must address, alongside increasing knowledge about its practices. Aside from undertaking a thorough research on the subject, there is also a need to educate and train healthcare practitioners on aromatherapy, provide them information that can be readily accessible to the public, and guide its appropriate access and delivery (Parkman, 2002). These efforts are not left unnoticed with the action of Washington State to pass legislation supporting integration of CAM therapies, including aromatherapy. in the dominant healthcare therapy. This law is in support of the patients' rights on their preference to receive CAM therapies, which is ensured by insurance coverage. Likewise, the California Board of Registered Nursing expressed a strong support for CAM therapies in the registered nursing practice, leaving no doubt about the usability of its products and practices among patients, including aromatherapy (ibid). An evidence-based practice on aromatherapy would involve the competency of a registered nurse to perform the skills required of the therapy. This is aligned to the purpose of a nurse being competent in CAM such as aromatherapy, when he/she consistently demonstrates the knowledge of this modality and its safe performance. There is indeed a need to undertake a thorough and sustained research on aromatherapy and the emerging trends that may likely be the result of its adoption in mainstream medicine. Such research is needed in the nursing profession and the healthcare environment, which need to deliver an evidence-based practice. This evidence-based practice will become the scientific and systematic basis of the service delivery in the healthcare environment, leaving the patient more taken care of in a patient-focused setting. The selection of this project, advancing aromatherapy in the mainstream medicine through aided research, will enable the researcher to meet his personal learning objectives of delivering a practice-based healthcare service grounded on both experience and research. The adoption of aromatherapy in the mainstream dominant healthcare services indicates the acknowledgment of the effectiveness and safety of its products and practices; only to be reinforced by constant studies of the nursing practice. This way, the delivery of aromatherapy services by healthcare practitioners will have a solid ground - just like how an effective practice-based healthcare delivery must be. It is clear that the project is aimed at providing a more efficient, systematic, and reliable delivery aromatherapy services, whose mainstream adoption has signaled its viability. It is believed that the proposed thorough and constant research of aromatherapy will significantly aid the nursing field and health practitioners to provide the same efficiency and viability, which researches are expected to pose as outcomes. Practitioners will also become more knowledgeable about the delivery of this service, integrating it to the general field of their study, alongside developing a supportive perspective. Hence, the anticipated outcomes for colleagues and clients of a research-based aromatherapy include a deeper knowledge of it, which would aid in carrying out an evidence-based practice deeply grounded on systematic basis, which practitioners find reliable and sustainable. The nursing practice in my area may be aided by this project in a manner where patients develop trust for aromatherapy as much as they trust the mainstream medicine and vice versa, to the point that there is no conflicting belief or perception between the two since they are both supported by pure science. 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