Psychiatry
Did you know the word psyche comes from the greek word for the
soul or butterfly?
Workshop
Background and Research Notes
Who are we?
Health and Safety - What are the policies and protocols?
Research links
Learning Objectives
Everyday Aromatherapy - case studies
in nursing with essential oils, Saloni Molhatra RN
Index
Tutors Individual Handouts
Who are we?
1. Your trainers
About Jan Benham FFHT MIFPA
Jan Benham is a natural cosmetic formulator and instructor. She teaches courses on making natural and organic products for body, hair, and skin in person. Beginning as a mobile aromatherapist and reflexologist Jan began teaching for Shirley Price Aromatherapy in 1980. Her case studies were
included in Shirley Price's Practical Aromatherapy published in 1982. Through her teaching and products Jan has assisted hundreds in learning the art and science of making 100% botanical natural products and has taught at top companies. Based in the Netherlands she teaches and consults with people in the UK, Canada and Asia. Jan is a certified aromatherapist, a fellow of the
Federation of Holistic Therapists and member of IFPA. Her professional work included Chairing the Canadian Federation of Aromatherapists. She and Sue Jenkins BSc MIFPA and the teaching team deliver the Shirley Price Aromatherapy Diploma, CPD courses and workshop training in NHS Trusts.
Jan is the author of "how to" books including The Creamy Craft of Cosmetic Making. Jan's passion is to teach others Holistic Beauty through making professional lotions, creams, soaps and other cosmetic products.
To learn more about Jan Benham and book a course, visit her website at http://www.janbenham.co.uk/
Jane Harrison M.A, Dip TM, Dip A, Massage Therapist and Trainer, Hands on
Publishing and Training.
Jane has worked for many years with people with learning disabilities. She has a particular interest in supporting people with multiple disabilities and understanding those who sometimes have challenging behaviour. She has been delivering this course since 1989. In Germany she studied Prekops
holding therapy and the educational healing work of Rudolph Steiner. After completing an MA in the Psychology of mental handicap she has worked in this field as a therapist and an educator and is based in Birmingham.
Jane co-authored Aromatherapy for People with Learning Difficulties with Shirley Price.
2. Shirley Price Aromatherapy Ltd
Shirley Price Professional Aromatherapy („SP.) was founded by Shirley Price
in 1974. Accreditations include the FHT, Soil Association, IFPA and the ATC.
The staff and educators of Shirley Price Aromatherapy Ltd serve the 6000
alumni of the Shirley Price Aromatherapy College with aromatherapy supplies
and training. SP are proud to have supplied 150 colleges with educational
supplies through distributors in 40 countries worldwide.
The Shirley Price Aromatherapy Diploma is held by authors, educators,
practitioners and college owners making it the most widespread and
respected qualification in aromatherapy. SP also provide CPD in massage
and reflexology. See our courses online.
Ian Brealey BSc FCA, Managing Director Shirley Price Aromatherapy Ltd.
As managing director I and my team including my son George Brealey BA
and Rosie Brandrick VTCT, College Secretary maintain professional contact
with thousands of aromatherapists through SP,and online through LinkedIn
and Facebook.
We are delighted to bring leading names in Aromatherapy Education to the
UK and on May 12,13 SP hosts the Robert Tisserand Weekend Seminar.
Details are on www.PureAromatherapy.com at Imperial College London.
The policy of the company is to research and promote the scientific uses of
essential oils in clinical and everyday aromatherapy. In 2011 the founder
Shirley Price received a lifetime award from the Alliance of American
Aromatherapists who cited her contribution to aromatherapy education and
her work on Parkinsons disease. In 2011 a fourth edition of Shirley Price.s
Aromatherapy for Health Professionals was published.
Confidential training is available to NHS Trusts in integrating aromatherapy
into differant branches of nursing based on the experience of the educators
and validation of the latest research.
What are the policies and protocols?
Sample Protocol
Many health professionals working in psychiatric units have been grateful for
strong sedatives when patients have become psychotic and unmanageable.
However there are some people who may just have a poor ability to cope with
life.
Protocol for coming off Benzodiazepine or night sedation with aromatherapy
Week 1 choose aroma from selection of 6 oils
Week 2 reduce medication by ¼
Week 3 reduce medication by further ¼
Week 4 remain on ½ medication
Week 5 reduce medication by ¼
Week 6 remain on ¼ medication
Week 7 ¼ medication alternative days
Week 8 ¼ medication alternative days
Week 9 ¼ medication twice a week
Week 10 ¼ medication once a week
Sample Protocol
Agitation
Apply a drop of Melissa oil to the pjama collar
Protocols Purpose
To outline the management of patients receiving
aromatherapy treatment
Definition
Clinical aromatherapy is the controlled use of essential oils to
enhance health and wellbeing which targets specific symptoms
Topical application
Refers to self massage, administration to the skin, a compress
with water, carrier oil or gel on cotton squares directly over
the affected area or bath or shower
Inhalation
Inhalation can be direct or indirect
Direct inhalation means applying two to five drops of essential
oil to a tissue and breathing normally for upto 15 minutes,
applying two to five drops of essential oil to a cotton ball
placed under a pillowcase or floating two to five drops of
essential oil on a bowl of hot water and inhaling the aroma for
upto ten minutes. Clients should remove spectacles and keep
eyes closed.
Indirect inhalation means an electric or battery operated
diffuser to diffuse fine particles of essential oil within a room
Carrier oil is a cold pressed vegetable oil. The most frequently used is sweet almond oil. Carrier oils have specific properties. Culinery oils are not suitable.
Patch testing is a process to determine whether a person is sensitive to allergens in an essential oil. Allergens are noted on the essential oil bottle. Two drops of the mixture at double the concentration to be used are put on an adhesive bandage on the clients upper arm and left for 12 hours.
Goals
To promote a sense of well being
To promote relaxation and reduction of stress
To reduce or alleviate physical, emotional symptoms
Indications
Stress and related disorders
Anxiety, depression, sadness, grief, anger
Insomnia
Digestive disorders, cramping, nausea
Pain
Muscular problems
Inflammation
Infection
Mental Agitation
Premenstrual syndrome, menopausal problems
Slow wound healing
Contraindications
Use with caution in pregnancy, epilepsy, hypertension, estrogen-dependent tumours, and patients with sensitivities and allergies. About 0.1% of people do not tolerate essential oils.
Policy
Essential oils should be used by health professionals trained in the use of essential oils. Such training and self development should be clinical and acceptable to * Hospital. Such training should cover safety precautions, potential side effects, and contraindications related to the use of each essential oil.
Contraindications
Epilepsy: Rosemary, lavender,
Estrogen related disorders (breast and cervical cancer, endometriosis, and enlarged prostate): basil, Clary sage and Fennel as a precaution since their hormonal action on the body isn’t known
Glaucoma: Melissa and lemongrass may increase pressure in the eyes as it does in monkeys
Heart fibrillation: Peppermint
Kidney and liver disease: no essential oil use
Skin irritation or delicate skin: Citronella, Clove Bud, Lemon, Eucalyptus, Bay, Lemongrass, Melissa, Marjoram and Thyme (all potential skin irritants)
Treatments should be offered after consultation with the client and after receiving their verbal consent or that of their family when applicable.
Treatment will vary with each patient and his and her needs
Essential oils used should be limited to the attached list
Full botanical name will be used in addition to the common name
Aromatherapy will be offered in addition to conventional treatments
Potential drug interactions with essential oils will be kept under review:
If sleeping pills are taken essential oils will increase the tranquilising effect
Pentobarbitol: Melissa or Valerian can increase the effects including sleeping time of barbiturate drugs. Inhaling cedarwood oil is stimulating and counteracts the sedative effects of these drugs.
The dignity of the patient will be respected at all times
A material safety data sheet is available for each oil
A health professional using aromatherapy for patient care will do the following
Check with patients about skin reactions to nuts, essential oils, perfumes, cosmetics or pharmaceuticals
Know how to take a proper case history to decide if the patient has a condition or is taking a drug which may contraindicate certain essential oils
Know how to perform a patch test and use this in appropriate cases
Ensure all undiluted essential oils (singles and mixtures) used by patients are adequately labelled and in bottles with integrated drop dispensers
Advise clients not to ingest essential oils (except as part of a specific treatment by a person with prescription authority for example peppermint capsules for bowel indications)
Have sufficient knowledge of clinical procedure to know when to avoid a particular procedure and when to obtain further medical assistance
PROTOCOL AND POLICY
Procedure
Assess client
Obtain history including allergies, medications, skin integrity and liked and disliked aromas.
Be aware of patient sensitivities see safety guidelines
Explain the procedure
Provide information about aromatherapy
Select essential oil and identify method to be used. Advise about photosensitivity when relevant.
Effects of inhalation are rapid. Topical action is slower.
Choice to be determined by patients condition and targeted outcome.
Ensure patients privacy. Provide treatment.
Be sensitive about others in the room
If a skin reaction occurs remove essential oil with milk or a carrier oil. Wash the affected area with scented soap, pat dry and leave in the open air for 10 minutes. Complete and occurrence report and notify the relevant staff. Provide follow up care.
Evaluate the patients response and document the treatment in patient records. Documentation includes treatment, essential oil used, method, and outcome.
PRACTITIONER SAFETY
Practicioner safety measures should include the following
Maintain good ventilation in treatment areas
Air the treatment room between treatment sessions
Wash hands before and after patient contact
Take a minimum of 5 minutes to breathe fresh air after every treatment
ACCIDENT PROCEDURES
Problem, Essential oil in the eye
Irrigate the eye with milk or carrier oil, then with water. Keep the bottle to show which essential oil was used. Seek medical assistance.
Problem, Used an undiluted essential oil (high phenols) skin burned Dilute with carrier oil then wash with unperfumed soap and water and dry. Seek medical assistance.
Problem, 5ml or more essential oil taken orally. Give milk to drink and keep the bottle. Seek medical assistance. Essential oils when taken undiluted in amounts greater than 5ml by mouth should be treated as poisons.
Problem, Bottle of essential oil dropped and broken. Essential oil and glass on the floor. Use a paper towel to soak up the essential oil and collect the glass. Dispose in a plastic bag.
GENERAL SAFETY
Storage
All essential oils should be stored as follows:
Locked up
Out of reach of children
In a cool place
In tightly closed containers
Away from food
Away from heat
Away from naked flames
Labeling
All bottles containing essential oils including mixtures should be clearly marked with indelible labels that include the following
Full botanical name
Relevant safety information
Quantity of oil
Supplier name and address
Barcoded where possible
Packaging
All essential oils should be packaged in coloured glass bottlesthat include an integral dropper (20 drops per ml)
Procedures
Essential oils should only be used in a clinical setting by a health professional trained in aromatherapy and who has permission to use them
Whenever possible essential oils should be used in enclosed areas to prevent aromas spreading
All essential oils used should be documented in the patient care plan
The positive and negative effects of essential oils should be evaluated and noted
Use topically in 1-5% dilution, except in specific situations as recommended in safety guidelines
When used in the bath essential oils should be diluted in a small quantity of milk to avoid splashing into the eye
Higher risk essential oils should be avoided
Clothing
No special clothing is required but some essential oils such as German chamomile can leave stains
Disposal
Essential oils are flammable and carry aromas so should be disposed of in a sealed plastic bag.
A list of essential oils considered safe in a clinical setting is set out below
ESSENTIAL OILS CONSIDERED SAFE IN A CLININAL SETTING
Oils highlighted in bold are those considered safe for health professionals to use after an introductory course of training.
Though commonly available is recommended the oils which are not highlighted are prescribed only by a qualified aromatherapist.
Angelica (Angelica archangelica, root)
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Basil a linalool (Ocimum basilicum)
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Bay (Pimenta racemosa)
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Benzoin Resinoid (Styrax benzoin)
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Bergamot (Citrus bergamia)
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Bergamot (Citrus bergamia) berg free
|
Cajeput (Melaleuca leucadendron)
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Camphor (Cinnamomum camphora)
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Cardomon (Eletaria Cardamomon)
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Carrotseed (Daucus carota)
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Cedarwood Atlas (Cedrus atlantica)
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Cedarwood himalayan (Cedrus deodora)
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Cedarwood Virginian (Juniperus virginiana)
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Chamomile German (Chamomilla recutita)
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Chamomile Roman (Chamaemelum nobile)
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Cinnamon leaf (Cinnamomum zeylanicum)
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Citronella (Cymbopogon winterianus)
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Clary Sage (Salvia sclarea)
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Clove Bud (Syzgium aromaticum)
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Cypress (Cupressus sempervirens)
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Elemi (Canarium luzonicum)
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Eucalyptus (Eucalyptus globulus)
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Eucalyptus (Eucalyptus citriodora)
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Eucalyptus (Eucalyptus radiata)
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Eucalyptus (Eucalyptus smithii)
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Fennel (Foeniculum vulgare)
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Fir Balsam (Abies alba)
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Fir Siberia (Abies siberica)
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Frankincense (Boswellia carteri)
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Galbanum (Ferula galbaniflua)
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Geranium Bourbon (Pelargonium graveolens)
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Geranium Egyptian (Pelargonium graveolens)
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Ginger (Zingiber officinalis)
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Grapefruit (Citrus paradisi)
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Helichrysum (Helichrysum italicum)
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Juniperberry (Juniperus communis)
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Lavandin (Lavendula Burnati)
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Lavender (Lavandula angustifolia)
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Lavender Spike (Lavandula latifolia)
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Lemon (Citrus limon)
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Lemongrass (Cymbopogon citratus)
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Lime (Citrus aurantifolia)
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Mandarin (Citrus reticulata)
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Manuka (Leptospermum scoparium)
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Marjoram Sweet (Origanum majorana)
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May Chang (Litsea Cubeba citrata)
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Melissa (Melissa officinalis)
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Melissa 3% (Melissa officinalis)
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Myrhh (Commiphora myrrha)
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Myrtle (Myrtus communis)
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Neroli (Citrus aurantium var amara)
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Neroli 5% (Citrus aurantium var amara)
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Niaouli (Melaleuca viridiflora)
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Nutmeg (Myristica fragrans)
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Orange Sweet (Citrus aurantium var sinensis)
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Palmarosa (Cymbopogon martinii)
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Patchouli (Pogostemon cablin)
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Pepper Black (Piper nigrum)
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Peppermint (Mentha x piperita)
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Petitgrain (Citrus aurantium var amara)
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Pine, Scotch (Pinus sylvestris)
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Ravensara (Ravensara aromatica)
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Rose otto (Rosa damascena)
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Rose otto (Rosa damascena) 5%
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Rosemary (Rosmarinus officinalis Cineole)
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Sandalwood (Santalum austrocaledonicum vieill)
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Spearmint (Mentha spicata)
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Spruce, Black (Picea mariana)
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Tangerine (Citrus reticulata)
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Tea tree (Melaleuca alternifolia)
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Thyme sweet (Thymus vulgaris ct linalool)
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Vetiver (Vetiveria zizanoides)
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Yarrow (Achillea millefolium)
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Ylang Ylang complete (Cananga odorata)
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CARRIER OILS CONSIDERED SAFE IN A CLINICAL SETTING
Almond (Prunus dulcis)
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Apricot (Prunus armeniaca)
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Argan (Argania spinosa)
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Avocado (crude) (Persea gratissima)
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Avocado (refined) (Persea gratissima)
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Blackseed (Nigella sativa)
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Starflower Borage (Borago officinalis)
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Calendula (Calendula officinalis)
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Camelia seed oil (Camellia oleifera)
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Carrier oil mix (avacado, grapeseed & wheatgerm)
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Carrot (Daucus carota)
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Coconut (fractionated) (Cocos nucifera)
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Evening primrose (Oenothera biennis)
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Flax linseed (Linum usitatissimum)
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Grapeseed (Vitis vinifera)
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Hazelnut (Corylus avellana)
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Hemp (Cannabis sativa)
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Hypericum St Johns Wort
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Jojoba Golden (Simmondsia chinensis)
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Jojoba Clear (Simmondsia chinensis)
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Kikui Nut (Aleurites moluccana)
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Lime blossom (Tilia europaea)
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Macadamia (Macadamia integrifolia)
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Melissa (Melissa officinalis)
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Moringa oil (moringa oleifera)
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Neem oil (Azadiracta indica)
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Olive oil (Olea europaea)
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Peachnut (Prunus persica)
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Pomegranate (Punica granatum)
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Rosehip (Rose canina)
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Safflower (Carthamus tinctorius)
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Sesame (Sesamum indicum)
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Soya (Glycine max)
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Sunflower (Helianthus annuus)
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Tamanu (Calophyllum inophyllum)
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Wheatgerm (Triticum vulgare)
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White lotion (parabens free
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Aroma botany
Basil is easily cultivated growing from seed in about 2 weeks in springtime and preferring a sandy soil and full sun. The palatable leaves are used in salads to improve digestion. The oil is steam distilled from the leaves and flowering tops. Linalool is an important component of the oil. Cautions: sensitive skin, pregnacy.
A Basil essential oil consisting of mainly methyl chavicol (estragole) is available and should be used with great caution. The Basil ct Linalool oil makes an excellent nerve tonic so Basil is one of the most useful essential oils to clear the head and restore strength and clarity to the mind. Its relative toxicity compared to other oils [LD50 g/kg of 1.4 (oral) 0.5 (dermal)] means its use in massage and compresses should be restricted to trained aromatherapists to ensure there is no possibility of overdose. If we have a massage oil of 30ml then at 1% essential oil even if only Basil essential oil were used thats roughly 0.3g for a 60-80kg adult so within a hundredfold margin of safety.
So therapists should not hesitate to make use of Basil. There are no such restrictions on the inhalation of Basil at all and all can enjoy its benefits.
melissa officinalis
You can get a long way in your aromatherapy learning by remembering these plants belong to just two of the most highly advanced plant families
LAMIACEAE (LABIATAE)
Lavender Lavandula angustifolia Mill. flowers
Clary sage Salvia sclarea L. herb
Marjoram Origanum majorana L. herb
Rosemary Rosmarinus officinalis L. herb
Peppermint Mentha x piperita L. herb
Basil Ocimum basilicum L. herb
Melissa Melissa officinalis herb
Thyme Thymus vulgaris ct thymol herb
Patchouli Pogostemon cablin Benth. leaves
LAMIACEAE (LABIATAE)
Lavender Lavandula angustifolia Mill. flowers
Clary sage Salvia sclarea L. herb
Marjoram Origanum majorana L. herb
Rosemary Rosmarinus officinalis L. herb
Peppermint Mentha x piperita L. herb
Basil Ocimum basilicum L. herb
Melissa Melissa officinalis herb
Thyme Thymus vulgaris ct thymol herb
Patchouli Pogostemon cablin Benth. leaves
RUTACEAE
Orange, bitter Citrus aurantium L. fruit
Bergamot Citrus bergamia Risso. fruit
Lemon Citrus limon (L.) Burm. fruit
Other plant families
Asteraceae
What is the important medical property of the Asteraceae, associated with a constituent produced in the distillation process rather than present in the plant...anti-in........ This is a plant associated with what energy, yin or yang in chinese medicine and with which planetary body in folklore?
Myrtaceae
Which important plant family was unknown until the discovery of australia?
Geraniaceae
Piperaceae
Rosaceae
By contrast with what plant family have we had an important relationship with for 40 million years?
Oleaceae
Which member is best left to enjoy at home?
Annonaceae
Santalaceae
Which wood is burned on honeymoon by middle eastern brides to relax their husbands?
Burseraceae
Styraceae
Zingiberaceae
Which member of the Zingiberaceae is useful in hospital setting for relieving nausea so getting and keeping the medication down and for digestion generally?
1. Aromatherapy in nursing, the Research
There is a great deal of interest in aromatherapy worldwide and British trained educators are in demand from the USA to China. In the area of mental health there is great interest in complementary treatments particularly ones which improve cognition. In 2004 the Nobel Prize for Medicine went to researchers who identified the genes concerned with the smell receptors of the nose opening up smell as never before to scientific research and understanding.
I recommend this webinar link as a summary of relevant research and introduction to aromatherapy
James Geiger MD
http://vimeo.com/33176990
this is an hourlong webinar on essential oils and their use in clinical aromatherapy. I found the review of the recent research very helpful in communications with health professionals. The medical terminology of 60 years ago used by Valnet is intelligible to therapists. However today the medical jargon and understanding of cellular level chemistry required to discuss the international scientific validation of aromatherapy treatments is not usually accessible to non scientists and non health professionals. This webinar sets it out in a very straightforward and well organised way.
http://vimeo.com/33176990
this is an hourlong webinar on essential oils and their use in clinical aromatherapy. I found the review of the recent research very helpful in communications with health professionals. The medical terminology of 60 years ago used by Valnet is intelligible to therapists. However today the medical jargon and understanding of cellular level chemistry required to discuss the international scientific validation of aromatherapy treatments is not usually accessible to non scientists and non health professionals. This webinar sets it out in a very straightforward and well organised way.
Research is very accessible on the PubMed database
J Clin Psychiatry. 2002 Jul;63(7):553-8.
· Aromatherapy as a safe and effective treatment for the management of agitation in severe dementia: the results of a double-blind, placebo-controlled trial with Melissa.
Source
Wolfson Research Centre, Newcastle General Hospital, Institute for Ageing and Health, Newcastle upon Tyne, United Kingdom. c.g.ballard@ncl.ac.uk
http://www.ncl.ac.uk/iah/about/contact/find.htm
useful links
http://www.ncl.ac.uk/iah/about/contact/find.htm
useful links
· Age UK
more
Below by Lane Simonian on Roberttisserand.com
"Various chemicals in essential oils help prove cognitive function in healthy individuals in three ways: by increasing the binding of acetylcholine to its receptors, by inhibiting acetylcholinesterase activity (as already noted), and by lowering acetylcholinesterase levels (by inhibiting phospholipase C gamma activity). Phospholipase C gamma (and beta) activity lead to the formation of amyloid plaques and peroxynitrites -the toxin held responsible for short-term memory loss in Alzheimer’s disease. Chemicals in various essential oils (including rosemary and sage) such as methoxyphenols (eugenol, thymol, and carvacrol) and if present rosmarinic acid and ursolic acid scavenge peroxynitrites (convert them into a less dangerous form). These compounds also reverse much of the damage that peroxynitrites do to transport systems, enzymes, tau proteins, and receptors involved in short-term memory (muscarinic acetylcholine), sleep (melatonin), mood (serotonin and opioid), social recognition (oxytocin), alertness (dopamine), and smell (olfactory). They also inhibit the influx of calcium thus limiting the death of neurons and the release of glutamate thus limiting the death of surrounding cells (see the following articles: Alkam, et al. “A natural scavenger of peroxynitrites, rosmarinic acid, protects against impairment of memory induced AB 25-35″ and Irie, “Effects of eugenol on the Central Nervous System: Its possible application to treatment of Alzheimer’s disease, depression, and Parkinson’s disease.”
Alzheimer’s disease can likely be effectively treated with aromatherapy using various essential oils.
Great as Shirley Price’s contribution was in the 1990s the outstanding contribution to the advance of aromatherapy in nursing in the last decade has been that of Jane Buckle. Her book clinical aromatherapy is now a standard text. Her partnership with the Planetree Hospital group in the USA has caused clinical aromatherapy to be taken to another level and attracted a rapidly accumulating body of research as methodologies improve and mainstream researchers are attracted by the subject.
The Royal College of Nursing (RCN) provides guidelines for nurses wanting to use aromatherapy. The guidelines for using aromatherapy issued by the RCN include the following:
Supervised practice
Anatomy, physiology, pathology and pharmacology
Practical and theoretical examination
Holistic approach
Supervised clinical practice
Counselling, communication and self development skills training
Appropriately qualified teachers
Support for trainee therapists
A sensible tutor/pupil ratio (RCN 1993)
Advances in Psychiatric treatments
Aromatherapy is one of the fastest growing of all the complementary therapies (Burns et al, 2002). It appears to have several advantages over the pharmacological treatments widely used for dementia. It has a positive image and its use aids interaction while providing a sensory experience. It also seems to be well tolerated in comparison with neuroleptic or sedative medication. The two main essential oils used in aromatherapy for dementia are extracted from lavender and melissa balm. They also have the advantage that there are several routes of administration such as inhalation, bathing, massage and topical application in a cream. This means that the therapy can be targeted at individuals with different behaviours: inhalation may be more effective than massage for a person with restlessness, for instance. There have been some positive results from recent controlled trials which have shown significant reductions in agitation, with excellent compliance and tolerability (e.g. seeBallard et al, 2002). aromatherapy in dementia (Holmes & Ballard, 2004) Further practice and research has confirmed the central roles of lavender and Melissa in dealing with agitation.
You can also see notes on the latest research with links on the
Shirley Price blog
2. Learning Objectives
This two-day course provides an introduction to aromatherapy and self massage in a clinical setting. Aromatherapy and massage techniques have been shown to be invaluable for supporting people with complex needs and to help understand challenging behaviours. They are also an excellent way to support people with learning disabilities to lead a more ordinary life.
Attending this course will enable you to:
· Learn simple and safe ways to use self massage and essential oils
· Explore the importance of touch and introducing self massage to develop communication and trust
· Make up your own aromatherapy oils
· Share ideas on how to apply what you have learned at home and within individual schools and day/residential settings.
- Research, theory……practice
Case studies provide an illuminating way to understand the uses of essential oils. Best practice is available in books, articles and online.
linkedIn
An excellent way of sharing best practice online securely and effectively is by setting up an linkedIn group for your workplace or specialty. You can then regulate who can join the group, see and participate in the learning discussions securely.
The Benefits of Clinical Aromatherapy in Hospice, Palliative, and End-of-Life Care – 9 Case studies
Saloni Malhotra RN BSN HNB-BC CCAP
I work as a RN Case Manager and Holistic Nurse Consultant and Educator for Compassionate Care Hospice (CCH) in Boston, Massachusetts. When I joined CCH in June 2008, the company was just opening its Boston office and was very receptive to using a holistic approach. At CCH we are utilizing reiki, guided imagery, music therapy, massage, art therapy, pet therapy, aromatherapy, and reflexology. In the previous three hospices I have worked for, some nurses did reiki, volunteers did massage, brought pets for visits, or played music, but an applied holistic approach care-planned is still virtually unheard of. Some hospices have a few lavender-bergamot blends made and use them for dementia patients, but have never used clinical aromatherapy to manage symptoms, where every blend is custom made with a look at the patient’s diagnosis, medication list, and allergies. This is what makes my job so unique and rewarding when I bear witness to the difference it makes in the life of my patients.
For the purpose of this paper I will be focusing and sharing with you what a blessing the use of clinical aromatherapy has been to our patients in improving their quality of life, often with astounding results. First a little bit about my journey and how I arrived to this point.
Nursing
Nursing is my second career; my previous degrees were in English literature and Mass Communication. Since both degrees were from India, I really could not proceed very far with them in the United States, and my aptitude test indicated I would do well in nursing. I graduated with a bachelor’s degree in Nursing in 1992 and took a circuitous route that involved hospital, rehab, and long-term care until I arrived at hospice and found my niche, as long as I got to do holistic. Having been born and raised in India until I was 22, my roots and upbringing kept me anchored to homeopathic, ayurvedic, herbal, and kitchen remedies. I also knew reflexology, some acupressure, massage, and meditation.
After getting my feet wet and adjusting to working in a hospital, I was restless and desired for something more from my nursing practice. I wanted to be able to bring more to my patients than I was able to provide. In 1994 and 1995, I learned reiki and found that piece. In 1996, I learned to teach reiki and found the more I taught, the more learning pathways appeared. At present, I am certified in 23 different modalities. I am also a registered aesthetician. Clinical Aromatherapy application is marvelous in both my practices.
I studied Dr. Jane Buckle’s Clinical Aromatherapy for Health Professionals program. It was taught by Kathleen Duffy in four modules. We studied chemistry, 33 essential oils considered safe for clinical use, and did a case study for each of the 33 oils, to cultivate a relationship between essential oils and carrier oils. It concluded with a research paper that had to be presented and defended and, of course, the written exam.
All this took a lot of time, effort, and money. The rewards from the study and applications have far exceeded my wildest expectations. They have elevated my nursing practice and improved the quality of care that I (and our hospice team) deliver to our patients. Clinical Aromatherapy is a passion I love to share with others.
Quality of Life & Death/Dying
In USA, Medicare has a specific criterion for hospice eligibility for each diagnosis. Every hospice has a team that encompasses a registered nurse, a social worker, a chaplain, and a home health aide to provide patient care. Volunteers are provided when accepted. The main goal for the team is to help the patient live and die in comfort and with dignity, while having their physical, mental, emotional, and spiritual needs met. I have often found the LIVE part often gets overlooked and all the focus is on dying. Time is of the essence for everybody, but especially when you are on hospice. A hospice team often has a very small window of opportunity to meet a patients living & dying needs. A patient’s needs encompass the patient’s caregivers and whomever they call family. Our hospice team collectively does the live and dies exceptionally well holistically.
CASE STUDIES
I will present 9 different patients and how they LIVED well and DIED well, and how Clinical Aromatherapy remedies assisted them to do so.
Patient privacy is being maintained, so all names have been changed. The diagnosis, treatment, and outcomes/results are factual.
Marlene P
Marlene was an attractive 56 year young woman, who had a diagnosis of stomach cancer with metastasis.
When I met Marlene for the first time it was for an informational, after her doctor’s office recommended hospice. The faxed paperwork indicated that Marlene had abdominal surgery to remove her stomach and the goal was to put a j-tube in, but when they opened her up, the cancer had spread all over the abdominal cavity. Given the fact that she had a history of juvenile diabetes, she was not a candidate for chemotherapy and/or radiation.
During our informational, Marlene was angry, weepy, and had a laundry list of complaints. Her doctor’s assistant had wished me, “Good Luck, she is the most temperamental patient we have. A real drama queen!” My intention when I saw her was to set aside that comment and be open to assist her to the best of my capability. She showed me her stomach incision: two centimeters looked infected, red, warm, swollen, and draining. She had severe nausea, her blood sugars were all over the place, she had not moved her bowels in five days, she hated taking medications, and she was in excruciating pain. She did not like taking “all these stupid pain pills that make me a space cadet.”
Marlene used half a box of tissues during our two hour informational. I knew she was anxious because she shred the tissues she used. She screamed, “Look at me! Just look at me! I was a perfect 140 pounds three months ago and now I am down to 103 pounds. I have no boobs left, look at my stomach I’ll never wear a bikini again. I am not ready to die.”
Marlene had questions about the holistic aspect of our hospice, which I answered while doing reiki per her request. She concluded our session by stating, “I think I will call Dana Farber for a second opinion about my cancer.” I left, wishing her well.
The next morning she called to request hospice because, “Whatever you did, I pooped after you left and my pain was less, I felt better and lighter.”
Marlene admitted herself to hospice. She was alone for both the informational and the admission. That in itself was unprecedented in my experience to date. Most patients have a significant other, children, siblings, a friend, or a health care proxy (HCP) with them; supporting them during the admission process. Marlene was estranged from everybody; she lived alone. Her daughters were estranged, as well as her significant other, an 80 year old wealthy man, who was with a younger woman so, “She can care for me. I am too old to take care of somebody who is dying.”
Marlene’s diverse needs presented a huge challenge to the team. My first visit post admission, I honored her request for no additional pills by bringing her a ginger essential oil sniffer to manage her nausea and vomiting. She used it (with refills) throughout her six months on hospice. She never needed any anti-emetic. She went on to eat with a preference for pepperoni pizza and macaroni and cheese. We did get her weight up to 117 pounds.
I used a blend of Tea-Tree and Myrrh in Aloe Vera for the infected incision and applied it two times daily until it healed. By then, Marlene was complaining about abdominal cramps and deep muscle pain. I used a 10% blend of Lemongrass and Clary Sage in Jojoba Oil. I ended up adding Sweet Marjoram because of its ability to increase peristalsis. She was on Dilaudid, a narcotic for pain management, refusing to be on a bowel regimen, but agreed to drinking 6 ounces of apple cider daily and eating applesauce three times a day to keep the bowels moving. By no means idyllic but it did the job. I want to add here that Marlene decided she wanted to rent a cottage at Hampton Beach one last time. We had to contract with another hospice in New Hampshire to visit her two times during that week, to meet her needs while she was there. She ended up extending her stay for two weeks. It was reported that she opened the cottage door for the New Hampshire Hospice nurse wearing a red bikini. The essential oils had healed her so well, there was no scarring. No conventional medical treatment would have allowed such healing, especially to somebody with low protein and albumin and metastasized with cancer. Wound healing protocols here also call for Zinc and Vitamin C. Her diet was not particularly good quality or protein rich.
Marlene’s anxiety was managed with flute music and a blend of Lavender, Bergamot, and Angelica. Angelica was used for its hug-around-the-heart benefit. After using a combination of guided-imagery/visualization, music, and aromatherapy, I invited her to visualize her perfect passing. We did this 6 times. Marlene passed exactly as we visualized. She stayed continent until 2 days before she passed, on very few medications, and she reconciled with her brother. He and her nieces were present, the flute music was playing, the scent of aromatherapy permeated the air, and she was in her own bed, with her hair looking perfect. Needless to say, Mother Nature’s bounty played a major role in helping her live well.
Peter P
Peter was a 72 year young engineer, a much loved husband, and a father of two children. He came to us with a diagnosis of Lung Cancer with metastasis to the brain. Peter was also status post surgery for removal of a brain tumor. His persistent headaches had prompted him to seek medical attention when they got really severe and unresponsive to Acetaminophen. By the time he was diagnosed, his cancer had metastasized to the point that it was difficult to pinpoint the originating site. He declined further treatment opting to enjoy the time he had left with his family.
His hospital discharge papers and prognosis gave him two weeks to live. His symptoms to manage were nausea, Charlie-Horses/severe leg cramps, and bilateral heels which had multiple cracks that were like fissures. The cracks were so deep you could have slid a dime halfway, and they were very painful.
Peter was admitted to our hospice at the end of November. He verbalized, “I just have two wishes, I want to live to see my only grandchild’s first Christmas, and I want to be able to walk up and down my living room holding and carrying him so that my daughter and son-in-law can sleep-in during the mornings when they come on Fridays from New Jersey.” Peter’s problem was the fissures in the heels, which made walking painful and difficult.
The only treatment I knew that could help his heels heal fast and also help with the Charlie-Horses/leg cramps was holistic - using essential oils. I explained this to Peter and his wife; I also made sure they understood that essential oils stained. They were open to Peter wearing sweatpants and doing a twice daily application of the blend I made. I used Almond oil with a 7% titration of German and Roman chamomile. I selected German chamomile because of its anti-inflammatory and analgesic properties, and Roman chamomile for its anti-spasmodic effect. The heels healed within 9 days; all fissures in both heels closed. Peter slept well all night without Charlie-horses, except for one night when he slept at his son’s house and forgot the essential oil blend at home. We used a ginger sniffer for the nausea throughout and visualization of him being present for his grandson’s Christmas. Peter passed peacefully at home surrounded by his family. He was on hospice for two months, without morphine or oxygen until his last week. Essential oil use gave his life the quality he desired. He had 5 weekends and Christmas morning of walking his grandson, until he was too weak.
Jim C
Jim came to us with a diagnosis of pancreatic cancer with metastasis to the brain. His symptoms to manage were severe pain, constipation, and depression. He was 87 years old. Jim also had the the worst case of psoriasis and eczema I had ever seen. Except for the soles of his feet and a very concave stomach, he pretty much had skin that was red, dry, flaky, peeling, blotchy, and itchy, as evidenced by numerous scratch marks on both arms and legs. I asked his sister, his health care proxy, if I could use some essential oils to treat his psoriasis. She replied, “Oh nothing works on him. Trust me we have tried everything over the years. Jim has had it since he was fifteen.” Jim had never been on a date, never socialized; he worked as a draftsman and lived with his mother until her death. He was a recluse and a well known local artist, whose work was bought by galleries and donated to libraries. Jim lived in an apartment in an affluent assisted living facility. He also had private twenty-four hour care. I was informed he never left his apartment.
On admission, we do a complete assessment. After spending two hours with him, I had no clue to his eye color, or whether his sclera was white or slightly jaundiced. Jim closed his eyes and would not make any eye contact. Jim was a man of few words, he hardly spoke and when he did his words were mumbled, so I had to ask him to repeat his answers. Of course, we treated him around-the-clock medically for severe pain and titrated bowel medication to prevent constipation both with medications and diet. I was obsessed with treating his psoriasis and eczema, so I could get him comfortable.
Jim’s sister had agreed to the use of an essential oil blend, provided she did not have to pay for another useless treatment. In his care plan, I identified Jim as also having social pain related to social isolation. There is no drug to ease social pain. I went home and pulled out my essential oils and Jim’s medication list to see what would be suitable. Over the years I have learned not just to use my book and studied learning, but also to trust my intuition. While mulling German Chamomile, Helichrysum, Frankincense, Myrrh, Mandarin Red, I rejected them for Jim and chose a 5% titration each of Lavandula Augustifolia and Bergamot. My intention while I made Jim’s blend was to treat his skin and his depression. I instructed the private care giver to apply the essential oil using the less is more effective principle twice daily.
Jim was seen daily until we had his physical pain and symptoms managed. The private caregiver was instructed to call the hospice number 24/7 with any changes, questions, or concerns. I had last seen Jim on Thursday; I stopped on Sunday to follow up on some medication concerns. Jim was not in his apartment. It really threw me off. All sorts of questions flew through my mind. Had he passed? Had the nurses at the assisted living facility sent him back to the hospital? I raced downstairs and asked the receptionist about him. She smiled at me and asked, “Are you Saloni?”
After my puzzled nod she gave me a hug and walked me towards the dining room.
I recognized the private caregiver, but I did not recognize Jim. This was not the Jim I had last seen on Thursday. His skin was clear, he was eating in the dining room, looking around, and smiling at people! I did a double take, and stopped five feet from the table and just stared, quite speechless. The private caregiver rushed to hug me exclaiming, “You are an angel. You made a miracle; he has no more skin problems. IT IS ALL GONE!” It had been 8 days since the essential oil was started.
I bent down and cupped Jim’s chin and said, “Jim you look absolutely amazing.” He cupped his hand over mine on his chin, made eye contact, his blue-grey eyes shining and smiling and whispered, “Thank you.” It was the sweetest gift I have ever received and one I will always cherish. A true miracle brought forth by clinical aromatherapy and some intuition. Jim’s social pain was history. His sister was ecstatic.
Jim was on service for three months. He was at activities, in the dining room, and at music performances. He lived and died well!
Ralph S
Ralph spent 19 months in the hospital with a whopping staph infection and bilateral necrotic heels and feet. Ralph had a left sided Cerebral Vascular Accident (CVA) several years ago and was bed and wheel chair bound. He was told he needed bilateral above the knee amputation (AKA) secondary to severe peripheral neuropathy and gangrene in multiple toes. Ralph agreed to get his right small toe and three middle left toes amputated but refused the Bilateral AKA. He was on multiple IV antibiotics and lost 70 pounds in the hospital. He begged his family to take him home. He got discharged to home with Clostridium-Diffecele, and multiple diabetic foot ulcers to the Visiting Nurses Association (VNA) for home care. After six months on VNA services, he was discharged to hospice as his feet, skin, and neuropathic pain got progressively worse. I met him and his drawer full of wound products during his post admission visit. After seeing the condition of both feet and legs, and talking to Ralph about his pain, I spoke with his daughter, his Health Care Proxy, and explained I used to be a wound nurse. I told her the products filled in the drawer were all good, but not what I desired to use for Ralph. With her approval and his physicians, I tried some holistic interventions that our hospice supplied. I started Ralph on a Tamanu oil leg and foot application. I picked Tamanu oil for its natural analgesic properties. I put Tamanu oil on a non-adhering pad and placed it against his heels and wrapped it in place.
Tamanu has been effective with burn patients and known to help with neuropathy. This was my intuition at work. Ralph’s feet were in such deplorable condition, they could not possibly get worse. His doctor, when he agreed to the treatment told me, “You will be calling me for Antibiotics all the time, just like the VNA nurses.”
Ralph has been on our hospice service since of July 2010. I have yet to call the physician for any antibiotics or medications! Ralphs toes continue to turn gray but bilateral necrotic heels have almost healed. When we first started the Tamanu oil there was drainage, and dressings were changed daily. Once the drainage stopped, the dressing was changed less frequency to two times each week.
Ralph is very prone to fungal infections of the groin, axilla, and abdomen. I have treated him with a 5% titration in Jojoba oil with Lemongrass and Palma Rosa, both selected for their anti-fungal properties. The mixture was applied once daily to the affected areas, and cleared in a week. We have done this 8 times since Ralph’s admission.
In October 2011, with a particularly bad snow storm with severe wind gusts and fallen trees, Ralph’s town lost power for 30 hours. His alternating pressure mattress deflated. When I saw him the next day he had progressed to a stage two wound. I used Tamanu oil again with a Tegaderm non-adhering island dressing that was changed every other day. The area healed within a week. Amazing Tamanu to Ralphs rescue!
Soon after we had the stage two healed, the home health aide left me a note to check the left side of Ralph’s neck. Ralph had always had a small pea size node near his left carotid artery. This node was now the size of a golf ball. I gently palpated the area and asked him if it hurt. It did not. I informed him since I did not know what it was, I would call his doctor and he could get it checked out. I spoke with Ralph’s daughter, who promised to get back to me after speaking with her four brothers, and getting their opinion. I did do reiki while I examined him and checked to see if the shape seemed regular or irregular. It was regular! Ralph expressed his desire to never have to go to a hospital again!
By my next visit three days later, his daughter had not yet called. Nature took the decision out of our hands the golf ball was oozing clear white drainage. I cleaned it with a normal saline gel, dried it, and applied an absorbent island dressing. I spoke with my boss about the necessity for daily visits secondary to the draining abscess’ proximity to the left carotid artery. The doctor and daughter were apprised about the change in condition.
The next day I used a 3% blend of Myrrh and Frankincense in an Aloe Vera gel. I picked Myrrh for its anti-tumor, anti-inflammatory, good for wound qualities, and Frankincense for its analgesic, cicatrizing, immuno-stimulant properties. I applied the blend on an absorbent island dressing and to Ralph. For the next two days it drained copiously. Day 3 it trickled, day 4 it had scabbed and was less than half the size. I continued with the treatment and some reiki. Day 7, it was draining copiously again, it followed the same trickle scab, smaller course, and I continued the daily treatment. Day 14, I pulled the island dressing off and out popped a teardrop size white cyst intact. That was quite a wow moment for both Ralph and me. Two days later with continued treatment the skin healed perfectly. Now you cannot even tell he had a gaping hole on the side of his neck, right by his carotid.
Karen H
Karen was discharged to hospice services after surgery for throat cancer/laryngeal cancer. She had a tracheotomy and a J-tube for tube feeding. Prior to admission, she had been in and out of hospitals five times in the three months, with bilateral pneumonias and a number of pulmonary infections treated with IV antibiotics. Karen and her family were open to using a holistic respiratory spray twice daily. I made her the following respiratory spray in a 5% titration.
A little background history lifted from my research project is necessary understand my respiratory spray: My research project for the clinical aromatherapy program was titled, “The Effectiveness of Lavandula Angustifolia, Rosemarinus officinalis, Eucalyptus globulus & Cymbopogon martini var.motia on Preventing Upper Respiratory Infections (URI’S) in High Risk Healthcare Professionals”
The idea for this study first germinated while reading Dr. Jane Buckles Book, Clinical Aromatherapy-Essential Oils in Practice. I was in awe reading that hat, boot, and luggage makers did not get sick during the Black plague because of the use of essential oils. I tested this by making a respiratory spray and involving my co-workers. The spray was used by each participant twice daily while in their car, to be breathed in a contained space. The control group had rose-essence used in middle-eastern cooking. For my project, I played around with a whole list of essential oils that prevent infection and tested various small blends in 2 ounce spritzer bottles. The internet is a veritable storehouse of information. Dr. Buckle recommends Bob Harris’ database site published research articles. Information can be found either by Essential Oil or by disease. Just typing the words aromatherapy and bronchitis yielded 15 Essential oils that help with Bronchitis. You can also read research blogs. After sifting through too much information I finally picked the following 4 oils for the experimental group in the study. Lavandula Angustifolia, Rosemarinus officinalis, Eucalyptus globulus and Palma Rosa, Cymbopogon martini var.motia.
The first oil picked is probably the most recognized Essential Oil on the planet- Lavandula Angustifolia (True Lavender). It is also one of the safest essential oils. True Lavender was picked for its anti-septic, anti-venous, anti-viral, anti-biotic-effective against MRSA (Nelson R.), Typhoid, diphtheria, tuberculosis (Valet’s) & 75% against Pseudomonas aeruginosa (Lorrondo et al). T. Lavender is also Fungi static (Perrucci et al), it may prevent fungal infections. True Lavender has anti-spasmodic qualities that would be beneficial for asthma, bronchitis, hay fever, and allergies. Since all the participants in the study were women aged 27 years old to 54 years old who worked in hospice, the PMS, calming, anti-depression-possibly as effective as Diazepam (Tissarand.R) were also deemed benefits from True Lavender.
The second oil Rosemarinus officinalis was selected for its anti-bacterial properties, because various studies indicate it is effective undiluted against 90-100% of some gram positive organisms as compared to gram negative organisms (Hethely et al). Rosemary Essential oil was tested to show good inhibition against Candida, Cryptococuss, and Mycobacterium. The relatively high anti-fungal activity of Rosemary could make it a potential in the use for AIDS patients with cryptococcal meningitis and pneumonia, and for a topical application to skin conditions and for diarrhea caused by Candida Albicans (Soliman et al). Rosemary was also selected because of its anti-inflammatory properties and because it increases alertness. All Hospice staff is on the road driving from patient to patient, using cell phones and juggling information, this was considered a fabulous added benefit.
The third oil Cymbopogon martini var.motia or Palma Rosa is a cosmetic industry favorite, particularly in “rose” soap. It has been found to be strongly anti-infectious, anti-fungal, especially Cryptococcus neoformans (Viollon et al), anti-bacterial-Staph aureus, E.coli, Klebsiella, Salmonella, Shigella, Vibrio (Pattnaik et al) anti-viral-the best antiviral (Maury.M), and an immune moderator working on Immunoglobulin A (IgA). Palma Rosa is considered by many the best oil to put into the air.
The fourth Essential Oil has been in use for a long time, Eucalyptus globulus, it is used in many proprietary brands like Vicks Vapor rub (most famous). Hmaamouch et al studied the anti-bacterial and anti-fungal properties of Eucalyptus essential oil and found that Eucalyptus inhibited the growth of 6 gram positive bacteria including MRSA and Staph aureus, its actions were comparable to orthodox antibiotics. It was found to be more effective against bronchial inspiration strains than any other essential oil. As a anti-viral, Eucalyptus had a concentration dependant antiviral effect when in contact with viruses prior to or during absorption (Schnitzer et al) Eucalyptus was also picked for its anti-inflammatory & analgesic properties. Eucalyptus was the most medicinal smelling of all the essential oils picked.
Dr. Jane Buckle replicated my study and cited it in the keynote address/PowerPoint presentation in Minneapolis this year.
Back to Karen, when she was admitted she needed to be suctioned very frequently, with thick copious secretions, clear because of recently finishing IV antibiotics. She was on hospice with a diagnosis of End Stage Pulmonary Disease-status post cancer. She also had malabsorbtion issues with her tube-feeding, was deemed a high risk for aspiration pneumonia, constipation, and skin issues. She also had some episodes of nausea and vomiting.
Karen had expressed a desire never to see the inside of a hospital again. Karen’s family of four sons and two daughters plus her alcoholic husband were divided on this issue. So, my primary goal was to make sure Karen’s needs were met. For seven months the respiratory spray kept her from having any respiratory infection. Guess what? None of the other occupants in the house got one either while the spray was used, six of those months were winter months!
Karen’s care involved frequent education and family meetings. Her skin broke down when she became incontinent. Tamanu oil healed it in no time at all. I know the power of essential oils kept her antibiotic free and aspiration free. She died with her skin intact despite being bed bound for the last 10 days.
Sherry H
Sherry came to us with a diagnosis of End Stage CVA. She had her first stroke before she was forty. She had a history of multiple strokes, and was completely bedridden, unable to move anything except her right hand that too, with limited range of motion. She is totally dependant for all activities of daily living. On admission, she had a stage three on her coccyx. She also had a caregiver, her husband, who is in very poor health, and not capable of expending energy to turn and reposition her every 2 to 3 hours. Sherry needs to be disimpacted two times a week, and has a Foley catheter, so incontinence had never been a factor in her skin breakdown, just poor circulation. Tamanu oil with a Duoderm dressing, changed two times a week healed the stage three, so well there were no tell-tale signs of there ever having a skin breakdown.
Sherry also had a long history of urinary tract infections. A peri spray of Lavender, Juniper, and Tea-tree, to clean her catheter at insertion site/peri area kept her free of a UTI while in my care.
She is currently transitioning to active after almost a year on hospice. There is no magic wand to have given her any more quality of life than to keep her husband supported and her comfortable, and away from any unnecessary antibiotics.
Paul G
Paul was a 92 year old very sharp, dapper, and well traveled widower, admitted with Colon cancer with metastasis. His symptoms were severe nausea, unrelieved by any anti-emetic: severe weight-loss, and weakness resulting in multiple falls. He also had a long standing history of constipation. Needless to say he was hardly eating, drinking, or retaining even if he did. Paul was very realistic that his prognosis was poor. Paul verbalized craving beef broth, eggs, and applesauce. Paul denied pain except for the occasional twinge, and the only thing that brought him anxiety was vomiting, or not being able to move his bowels every second or third day. It was a challenge to get him to take any bowel medications. Paul was skeptical, but he agreed to a ginger sniffer and an oil to rub on his stomach.
I took Paul a ginger sniffer the next day. He reluctantly held it to his nose and inhaled; He announced, “The real test will be if I can keep broth down.” He never vomited after he got the ginger sniffer. Paul lost it once, it fell from his pocket into the toilet bowel, and he raved and ranted at the aide for not letting him fish it out of the toilet. He was extremely panic stricken without the sniffer, and effusive with his words of gratitude when he had another one delivered within two hours. An oil blend of Sweet Marjoram for its ability to strengthen peristalsis and Lemongrass to help with organ pain was used to massage his abdomen twice daily. Paul passed after six weeks of beef broth, scrambled eggs, and lots of applesauce, thanks to a ginger sniffer. He was out of it for the last two days, but the assisted living staff and private care givers had noted his attachment to the sniffer, and anxiety if you removed it from his hands while he was actively dying. Paul died holding his ginger sniffer. I asked the funeral home to leave it in his hand. Paul was very extremely bowel fixated, and I had a challenge on my hands, because of his non-compliance with medication recommendations. The massage oil, reiki, and enemas every three days kept Paul on an even keel moving his bowels until the day before he passed. The assisted living nurses were absolutely amazed at what essential oils had achieved.
Bob T
Bob came to us because he had chronic kidney failure, an explored mass on his liver. His appetite had decreased and he was refusing to eat. Bob was also an insulin dependent diabetic with stage four diabetic foot ulcers. He had an ongoing picking disorder. His skin was a mess of scabs in various stages, bleeding, scratch marks, flaky, raw, red, and peeling. After three years of trying every pharmaceutical treatment the staff had ruled in that nothing worked. Bob’s niece, his HCP, and the nurse practitioner agreed to have the hospice aide use a blend of Lavender, Bergamot and Myrrh. I have mentioned reasons for using Lavender and Bergamot before, Myrrh was used for its anti-inflammatory properties, and being great for dry skin. The staff was in awe with the results. He passed with his skin on the rest of his body (barring diabetic foot ulcers) intact.
Susan K
Susan was 91 years young with a diagnosis of small cell lung cancer with metastasis, status post chemotherapy. She had severe nausea and weight loss. She was also in deep denial of end of life on the horizon. Susan would deny pain, deny diarrhea (a side effect of Tarveva), deny loss of appetite, and deny that she was sick. She disliked the way she looked with her hair loss but refused to wear a wig. As a nurse, a patient who wears a mask of contentment and smiles at you while (FLACC, a scale assessing pain by looking at the face, legs, arms, crying, and consoling, with two points for each) I was scoring Susan a 5 for pain. A patient denying pain can be more challenging than a patient who is temperamental or belligerent. Why? Because, pain is subjective, we cannot tell the patient we know that they are lying. That pain is etched into their face and reflected in their movements. All we can do is ask the same question three different ways: Does anything hurt? Are you uncomfortable? Are you in pain?
When a patient wears a social mask and a smile and treats the nurse like she is a social obligation, there is no initiating a plan to make things comfortable for the patient. The patient continues to suffer by their denial. No hospice issues a magic wand to its nurses. It all starts with the nurses intention to assist a patient live and die comfortably by doing their best to manage their care. I felt like a failure when visit after visit, was spent only supporting the patient’s daughter, as mom continued to decline and deny her pain. I intuitively changed strategy and met the patient on as a social visit, discussing a common interest in art, attempting to foster a relationship that evolved from friendship and mutual interests.
My break arrived when the patient’s daughter asked me to check the area under her mother’s breasts. Susan had a fungal infection, and I offered to treat it with an essential oil, but did not like fragrances. She was very skeptical about the effectiveness, but upon her daughter’s encouragement, she agreed to try it if the smell did not bother her. I made a 5% titration of European basil and Fennel both for their anti-fungal properties and because they were familiar as herbs used in cooking. The rash was history after four days. This gave me a rung up into building some trust. Once the trust came, the pain got managed.
A spiritual synergistic blend of Frankincense, Myrrh, Rose, Sandalwood and Ylang Ylang, was used to help her pass, as she struggled to let go. She smiled and squeezed my hand, as her daughter said, “Mom, Saloni says its time to go.” She half smiled and said, “I know.” Susan squeezed my hand again. I told her daughter, “This is her goodbye. She is ready to go.”
Her daughter said, “She has been trying to go for over a week.” Susan went early the next morning. Susan was not the first person who was struggling to die that this spiritual blend helped let go. Susan’s case was just the most challenging and memorable because I had to work outside my comfort level to foster an outside relationship in order to meet her needs. I could not have done it if I was not passionately enamored with further discovery with essential oils and their clinical applications.
Parting Notes
In three and a half years, I have had the opportunity to use many holistic remedies and interventions. Hundreds of patients in our hospice have benefited with the use of clinical aromatherapy, and lived well & Died well because it enhanced their care. I know I have barely scratched the surface in terms of the use of essential oils in my practice. I dislike using the word conclusion, because it seems so final. I am happy to answer any questions, or dialogue to expand my own knowledge and encourage others to explore and learn about aromatherapy or hospice. I can be reached @ reiki_woman@yahoo.com.
Saloni Molhatra
DIGEST of conditions and oils
Analgesic
Tamanu oil
Antibactrial
Lavender, Juniper, Teatree
Anxiety
Angelica, Bergamot, Lavender
Cracked heels
German, Roman Chamomile, Almond
Cramp
Clary sage, Lemongrass, Sweet Marjoram, Jojoba
Fungal infection
Lemongrass, Palmarosa, Jojoba
Basil, Fennel
Nausea and vomiting
Ginger
Social pain
German chamomile, Helichrysum, Frankincense, Myrhh, Mandarin Red
Spritual
Frankincense, Myrhh, Rose, Sandalwood, Ylang
Upper Respiratory Infections
Lavender, Rosemary, Eucalyptus, Palma Rosa
Wound healing
Myrhh, Tea tree, Aloe Vera
Myrhh, Frankincense, Aloe Vera
References
Buckle J. (2003). Clinical Aromatherapy, Second Edition. Churchill Livingston.
Nelson R (1997) In vitro activities of five essential oils against MRSA and Vancomycin-resistant Enterococcus faecium. J Antimicobial Chemotherapy. 40305-306
Valnet J. (1990). The practice of Aromatherapy. Healing Arts, Rochester,VT. P148
Larrando J, Agut M, Calvo-Torres M. (1995) Antimicrobial activity of essences from Labiates. Microbios 82: 171-172
Perrucci S, Macchioni G, Cioni P C et al. (1996) The Activity of compounds from Lavandula angustifolia against psoroptes cuniculi. Phytother res. 19 (1) 5-8
Tissarand R. (1998) Lavender beats benzodiazepines. Journal of Aromatherapy. 1, 1. 2.2
Hethely I, Kaposi P, Domonkox J, Kernoczi Z. (19870 GC/MC investigation into EO’s of Rosmarinus officinalis. Acta pharm hung. 57 (3-4) 159-169
Soliman F, EL-Kashoury E et al. (1994). Flavor Fragrance Journal.
Voillon C, Chaumont JP. (1994. Antifungal properties of essential oils
And their components upon Cryptococcus neoformans. Mycopatholgia. 128 (3) 151-153
Pattnaik S, Rath C, Subramanyam V R, Kole C R, Sahoo S. (1995) Antimicrobial activity of essential oils from Cymbopogen : inter and intra-specific differences. Microbios. 84: 239-245
Maury M. referenced from Clinical Aromatherapy for Health Professionals. Copy right 2006 Jane Buckle.
Schnitzer P, Schon K, Reichling J. (2001) Antiviral activity of Australian tea tree oil and eucalyptus oil against Herpes simplex virus in cell culture. Pharmazie. 56: 343-347
- INDEX
Patricia Davis, Aromatherapy An A-Z (2000) is available on the Amazon Kindle and so forms a useful first stop for reference. Described as “one of the most thoroughly researched books on aromatherapy. The International Jounal of Aromatherapy”.
For the Serious students of Aromatherapy
Battaglia Salvatore (2003), The Complete Guide to Aromatherapy.
Sue Clarke, Essential Oil Chemistry, also available on Amazon Kindle
Clinical Aromatherapy
Buckle Jane (2003) Clinical Aromatherapy Essential Oils in Practice
Price S (2011) Aromatherapy for Health Professionals
Nursing references
Dixon Michael, Sweeney K (2000) The Human Effect in medicine, Theory, Research and Practice
Oxford Dictionary of Nursing
Self Instruction in Mental Health Nursing, Ironbar and Hooper (1989)
Aroma Psychology
Herz R (2007) The Scent of Desire
Aromatherapy References
Benham J, (2007) The Creamy craft of Cosmetic Making
Bensouillah J, Buck P (2006) Aromadermatology
Brealey I, et al (2012) Everyday Aromatherapy
Caddy R, (2005) Essential oils in Colour, essential oil uses and chemistry
Keville K and Mindy Green (2009) Aromatherapy a complete guide to the healing art
Maury M (1961, in english 1989) Marguerite Maury’s Guide to Aromatherapy, The secret of life and youth
Sanderson H., Harrison J., Shirley Price (1991) Aromatherapy and Massage for People with Learning Difficulties
Tisserand RB (1985) The Art of Aromatherapy
Tisserand RB Essential oils Safety
Westwood C (2004) Aromatherapy Stress Management
Valerie Ann Worwood The Fragrant Pharmacy, a highly regarded source of aromatherapy blends
5. Tutors handouts
The tutors provide individual handouts
Introduction to
Aromatherapy
Clinical aromatherapy is the controlled use of essential oils to enhance health and wellbeing which targets specific symptoms
Indications
Stress and related disorders
Anxiety, depression, sadness, grief, anger
Insomnia
Digestive disorders, cramping, nausea
Pain
Muscular problems
Inflammation
Infection
Mental Agitation
Premenstrual syndrome, menopausal problems
Slow wound healing
