Setting up an Aromatherapy Program for Hospice

By Kathy Bonnell, RN, BSN, CHPN, HTP

At Hospice our goal is to keep our patients as comfortable as possible. Since the Essential Oil academy states that “As a holistic practice, Aromatherapy is both a preventative approach as well as an active method to employ during acute and chronic stages of illness or ‘dis’-ease” (Essential oils academy, 2017 ), we decided with CAM being more main stream, we would set up an aromatherapy program. Our goal was to use essential oils to calm patients, reduce pain and discomfort, reduce nausea, reduce wound odors and to achieve an overall sense of wellbeing.

At Hospice our goal is to keep our patients as comfortable as possible. Since the Essential Oil academy states that “As a holistic practice, Aromatherapy is both a preventative approach as well as an active method to employ during acute and chronic stages of illness or ‘dis’-ease” (Essential oils academy, 2017 ), we decided with CAM being more main stream, we would set up an aromatherapy program. Our goal was to use essential oils to calm patients, reduce pain and discomfort, reduce nausea, reduce wound odors and to achieve an overall sense of wellbeing.

When looking to set up an aromatherapy program for Hospice, we had a lot of questions. What did we want to accomplish?  What would it cost?  What were the regulations on essential oils? How safe are they?  How would we administer them? Who would administer them?  What oils should we use? What kind of training would our staff need?

What we wished to accomplish was probably the easiest question to answer. We want our patients to be comfortable and peaceful.  Our most distressing symptoms to the patients and families are wound odor, nausea, anxiety, lack of appetite, respiratory distress and pain.  What ways could essential oils help? Looking through my textbook­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­, Aromatherapy Certification level I, I looked at the calming influence of essential oils. What should we use: Chamomile Chamaemelum nobile, or Lavender Lavandula agustifolia?  For nausea what would be the best; lavender Lavandula agustifolia, or Chamomile Chamaemelum nobile or Peppermint Mentha x piperita?  To combat wound odors should we use Tea tree oil Melaleuca alternifolia, or lavender Lavandula agustifolia. To increase appetite should we use Orange oil Citrus sinensis or Ginger? For respiratory distress should we use Peppermint Mentha x piperita or Orange oil Citrus sinensis?

As a non- for- profit agency, I, also, had to look at cost. As most CAM is not paid for by insurance, and Hospice receives a daily stipend for each patient (no matter what is given to them in time, equipment or medications),   Hospice would be paying for the essential oils. So carefully looking at cost was, also, a necessity.

Cost was an interesting aspect of this project. I started with our local pharmacy to see what they could do. They were unexpectedly expensive. Looking at two of the higher end essential oil companies DoTerra and Young Living, I priced essential oils. Realizing that we also needed bottles, labels and a way to administer the oil, I did some major price comparison shopping. Using the charts in our book, I found that I could do this cheaper and easier than dealing with the local pharmacy.

Safety was another big issue. Even though our teaching was to include not applying to skin or ingesting, I wanted to look at oils that would be safe if accidently applied to skin. My research, also, had me looking at what was being done locally. The local hospital was using aromatherapy and after reading their information, I spoke to our medical director, since most CAM and essential oils recommend that you speak with your doctor about usage and safety. He agreed that aromatherapy would be safe and helpful to our patients. Essential oil data sheets from the class text book were added to our data safety sheets.

So after much deliberation, our CAM committee decided on essential oils that had multiple usages and a wide range of scent. We decided to use: lavender Lavandula agustifolia, orange oil Citrus sinensis, and peppermint Mentha x piperita.

Since Lavender Lavandula agustifolia alone, potentially, could handle most of our major issues; wound odor, nausea, anxiety, and pain, we then looked at essential oils that had a dissimilar scent pattern. Peppermint Mentha x piperita, although, originally looked at for nausea, also works well on muscle aches, mental fatigue, reduces stress, neuralgia and respiratory complaints. Orange Oil Citrus sinensis also holds a wide range of usage. It is good for the nervous system, being soothing, helps with digestion, appetite, and with respiratory complaints.

We decided that our oils should go out as a kit. All three oils would be placed in small (2ml) bottles. We would label the bottle with the common name of the oil but on the bag would be sticker including Warning: Use as directed. Do not use if pregnant or nursing. Avoid eyes and mucus membranes. May irritate skin. Keep out of reach of children. Do not ingest.

On the other side the label would say: Lavender Oil Lavandula agustifolia for wound odor, nausea, anxiety and pain. Peppermint Oil Mentha x piperita for nausea, muscles aches, mental fatigue, reduces stress, neuralgia and respiratory complaints. Orange Oil Citrus sinensis for soothing nervous system, aid with digestion and aid with appetite.

Since one of the ways essential oils enters our body is through the sinuses, we decided that inhalation was the easiest way to administer these oils. We would apply several drops to a cotton ball (included in our kit) and place near the patient’s head or if the patient was alert allowing them to bring the cotton ball closer to the olfactory system by placing the cotton ball in their cupped hands and taking several deep breaths. If the family has or wants to purchase a diffusor that could also be used.  Depending on where the patient was in the dying process, adding several drops to simmering water could also be used.

One of the most difficult cycles in Hospice to break is; I am having difficulty breathing therefore I am anxious. I am anxious; therefore, I am having difficulty breathing. We find that if we can break the anxiety, the patient has less difficulty breathing.  Since all three oils can be used to reduce stress, and both Peppermint Mentha x piperita and Orange Oil Citrus sinensis help with respiratory distress we hope to have another way to break this pattern.

Pain is frequent with the dying patient. Lavender Lavandula agustifolia helps to calm and to reduce pain. If the patient is calm, they will have less pain. Peppermint Mentha x piperita and Orange Oil Citrus sinensis also helps with neuroglia which is a frequent complaint as the body is shutting down.

Lack of appetite is the one of the most distressing symptom for the family. We realize that if our loved one does not eat they will die. Orange Oil Citrus sinensis helps to stimulate the appetite without putting stress on the body like some traditional appetite stimulants do. Families like to feel that they have done everything possible to get the patient to eat.

We began our teaching. We taught all or direct care staff the how, when and why to administer essential oils. We developed a pamphlet on the use of essential oils for our admission pack. We devolved a care plan in our computer system to make it easier for our staff to use. We, even, developed a FAQ sheet to help the staff answer questions. Policies and Procedures were also a necessary item.

While our program is still in it’s infancy, we are seeing positive results. Staff are asking for and recommending the oils for patients. Not all patients agree to usage but a lot do. Because essential oils are considered “non- invasive”, families are more willing to try them than medications or “narcotics”.  Now comes that statistical part of my project, does it work? I have faith that the numbers will prove a positive result.


References:

http://www.aromaweb.com/articles/saftey.asp

https://naha.org/explore-aromatherapy/about-aromatherapy/what-is-aromatherapy.

http://www.essential-oils-academy.com/

http://www.essentialoilshaven.com/best-essential-oils-brands/

http://www.umm.edu/health/medical/altmed/treatment/aromatherapy

Lakhan, S., Sheafer, H., and Tepper, D. (2016). The effectiveness of aromatherapy in reducing pain: a systemic review and meta-analysis, Pain Research and Treatment Vol.2016.

  1. Louis and S.D. Kowalski, Use of aromatherapy with hospice patients to decrease pain, anxiety, and depression and to promote an increased sense of well-being, The American journal of hospice and palliative care,Vol.19,no.6, pp.381-386, 2002.

Park Totilo, R. (2015). Aromatherapy certification program level 1: St. Petersburg, FL.

Shakespeare, W. (2017). The complete works of William Shakespeare , Vol. 9 of 9: Othello; Anthony and Cleopatra; Cymbeline; Pericles (classic reprint).