Aromatherapy
Jane Buckle
Nurse Healer OBJECTIVES
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Theoretical
Describe the historical path of aromatherapy, from ancient times to the present renaissance.
Describe the relevance of learned memory in the choice of essential oil.
Compare the different methods of using essential oils.
Discuss the safety issues of using essential oils.
Clinical
Describe the use of aromatherapy for insomnia.
Describe the use of aromatherapy for chronic pain.
Describe the use of aromatherapy for infection.
List three uses for essential oil of Lavandula angustifolia.
List three uses for essential oil of Eucalyptus globulus.
List three uses for essential oil of Mentha piperita.
List three uses for essential oil of Melaleuca alternifolia.
List three uses for essential oil of Boswellia carteri.
Personal
Integrate aromatherapy into your daily life to enhance your well-being.
Experience each of the five essential oils mentioned previously, both inhaled and topically.
DEFINITIONS
Aromatherapy: The use of essential oils for therapeutic purposes.
Chemotype: A cloned variety of a plant that always has the same chemistry.
Clinical aromatherapy: The use of essential oils for specific, measurable outcomes.
Essential oil: The distillate from an aromatic plant, or the oil expressed from the peel of a citrus fruit.
Learned memory: The ability of the mind to condition the response to an aroma based on previous experience.
Limbic system: The oldest part of the brain; it contains the amygdala, hippocampus, thalamus, and hypothalamus.
‘M’ Technique: A registered form of very gentle, structured touch suitable when the receiver is very fragile, actively dying, or the giver is not trained in massage. Recognized as part of holistic nursing care.
▪ HISTORY
Aromatherapy is often misunderstood and maligned because many people think aromatherapy is just about inhaling aromas. Aromatherapy is part of herbal medicine that dates back 6,000 years and has been used in many parts of the world. According to the World Health Organization, more than 85% of the world population still relies on herbal medicine, and many of the herbs are aromatic.
The renaissance of modern aromatherapy began in France just prior to World War II, at about the same time the first antibiotics were being introduced. A medical doctor, Jean Valnet, a chemist, Maurice Gattefosse, and a surgical assistant, Marguerite Maury, were key figures in the rediscovery of this ancient art of healing. They did not use aromatherapy for nice aromas or for stress reduction, two of the most popular ways aromatherapy is used today; they used aromatherapy clinically to help wounds heal, to fight infections, and to reduce skin problems, and they used essential oils topically.
This more clinical approach to aromatherapy has survived in France and Germany, where aromatherapy is seen as an extension of orthodox medicine. German doctors and nurses are tested in the use of essential oils to become licensed. The clinical use of aromatherapy is easy to understand, as many of today’s drugs originally came from plants: for example, aspirin from willow bark and digoxin from foxglove. Even the contraceptive pill originally came from a plant— the humble yam—and the yew tree produces a cytotoxic drug to fight cancer.
▪ THEORY AND RESEARCH
Aromatherapy uses essential oils obtained from aromatic plants for the physical, psychological, and spiritual benefit of the patient. Essential oils are powerful; they can be up to 100 times more concentrated than the herb itself. Many essential oils have familiar smells, such as lavender, rose, and rosemary. Essential oils are highly volatile droplets created by the plant to prevent (or treat) infection, regulate growth, and mend damaged tissue. These tiny droplets are stored in veins, glands, or sacs by the plant, and when they are crushed or rubbed, the essential oil and its aroma are released. Some plants store large amounts of essential oil, some store very little. This, along with the difficulty of harvesting the essential oil, dictates the price of each type of oil. More than 220 pounds (100 kilograms) of fresh rose petals are needed to produce a little more than 2 ounces (60 grams) of essential oil, making rose one of the most expensive essential oils, and therefore one of the most frequently adulterated.
There are a few important things to know about essential oils before they can be used safely: extraction, the botanical name (for clear identification), method of application, safety, storage, and contraindications. These topics are discussed in the following subsections as well as in Exhibit 25-2, later in this chapter.
Extraction
Only steam-distilled or expressed extracts produce essential oils. These two methods give a product with no additional solvent or impurity. However, many “essential oils” on the market are actually extracted with solvent, which can produce allergic or sensitive reactions in the user. A bottle of essential oil should state that the contents are pure essential oils: steam distilled or expressed. (Only the peel from citrus plants such as mandarin, lime, or lemon produces an expressed oil.)
Identification by Botanical Name
It is very important to know the botanical name of a plant because there can be many different species of the same plant, and using just the common name can lead to confusion. For example, there are three species of lavender and many hybrids, each with different chemistry and, therefore, very different therapeutic effects. There are 400 different species of eucalyptus. Identification is simple if the full botanical name is given. This should include the genus, species, and where relevant, the chemotype. The genus of lavender is Lavandula, and so all lavender plant names begin with Lavandula. The species is the second part of the name. The chemotype, if there is one, comes last. See Table 25-1 for a list of the botanical and the common names for the essential oils mentioned in this chapter.
Do not buy just anything that is labeled “lavender oil” because there is no way of knowing
which lavender is in the bottle. One lavender is soothing, calming, and exceptional for burns, but another lavender is a stimulant and expectorant (helps someone to cough up mucus). This second lavender will not promote sleep or soothe burns.
which lavender is in the bottle. One lavender is soothing, calming, and exceptional for burns, but another lavender is a stimulant and expectorant (helps someone to cough up mucus). This second lavender will not promote sleep or soothe burns.
TABLE 25-1 Essential Oils Mentioned in This Chapter | ||||||||||||||||||||||||||||||||||||||||||||||||||
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Methods of Application
Essential oils can be absorbed by the body in three ways: through ingestion, through olfaction, and through topical application. For methods of using essential oils that are congruent with holistic nursing practice, see Exhibit 25-1.
Touch in Aromatherapy
Aromatherapy often is used with massage or the ‘M’ Technique.1 This registered method of touch is suitable when massage is inappropriate, either because the receiver is too fragile or the giver is not trained in massage.2 The ‘M’ Technique is used in hospitals, hospices, and long-term care facilities in the United States, the United Kingdom, the Netherlands, and South Africa. It is simple to learn and produces a profound relaxation response in just a few minutes, reducing perceptions of chronic pain, agitation in dementia,3 and at the end of life.4 The ‘M’ Technique appears to be more relaxing than conventional massage and to have an accumulative effect.5 Gentle stroking enhances absorption of essential oils through the skin into the bloodstream. (For more details on this method of very gentle, structured touch, the how-to DVDs, the 2-day practitioner, and 4-hour
hand and foot ‘M’ Technique training programs, please see www.rjbuckle.com.)
hand and foot ‘M’ Technique training programs, please see www.rjbuckle.com.)
EXHIBIT 25-1 Methods of Application
Inhalation: 1-5 drops undiluted
Topical
In baths: 1-8 drops
Compresses: 1-8%
‘M’ Technique or massage: 1-10%
Wounds: 12-40% (depending on chemistry of essential oil)
Burns, bites, and stings (first aid): 100%
Radiation burns: 3-10%
Vaginal: Useful for yeast infection or cystitis. Use 1-5% diluted on tampon.
Ingestion: This is not accepted as part of holistic nursing care.
Olfaction
The fastest effect from aromatherapy is through olfaction.6 Essential oils are composed of many different chemical components that travel via the nose to the olfactory bulb. There is debate as to whether the components are recognized by shape or vibration;7 either way, they trigger responses in the limbic system of the brain—the oldest part of the brain—where the aroma is processed. The limbic part of the brain contains the amygdala, where fear and anger are analyzed; the thalamus, where pain is analyzed; and the hippocampus, which is involved in the formation and retrieval of explicit memories. This is why an aroma can trigger memories that have lain dormant for years. Smell is very important, beginning with the newborn baby’s identification of its mother and continuing into old age, where studies show that the depression of residential older adults can be reduced with the aromas of familiar fruits and flowers.
The effect of odors on the brain was “mapped” using computer-generated graphics.8 Brain Electrical Activity Mapping (BEAM) indicates how a subject, linked to an electroencephalogram (EEG), rates different odors even when the subject is asleep.9 These maps indicate that aromas can have a psychological effect even when the aroma is subliminal (i.e., below the level of human awareness), and that, provided the olfactory nerve is intact, the aroma still has a measurable effect on the brain.
Topical Applications
Components within essential oils are absorbed into, and through, the skin via diffusion. The two layers of the skin, the dermis and fat layer, together act as a reservoir before the components within the essential oils reach the bloodstream. There is some evidence that massage or hot water enhances absorption. Essential oils, because they are lipophyllic (dissolve in fat), can be stored in the fatty areas of the body and can pass through the blood-brain barrier and into the brain itself.
Negative Reactions
Essential oils are commonly used in the pharmaceutical, perfume, and food industries.10 Pure essential oils rarely produce an allergic effect, unlike synthetics. Today, increasingly more essential oils are being replaced with synthetic copies.
Nursing Theory
Aromatherapy links into many of the most recognized nursing theories. Certainly, it resonates with Watson’s Theory of Caring because aromatherapy allows nurses a method of showing their care at a deep level.11 It resonates with Barrett’s Theory of Power because it allows the patient to participate knowingly in change and offers a model for change through empowerment.12 Nightingale put forward the first theory
of nursing—putting the patient in the best condition for Nature to act—and thus aromatherapy clearly fits here because it allows the patient to relax sufficiently for the healing process to occur from within.13 Nightingale also suggested creating an environmental space conducive to healing—aromatherapy fits very well here as well, because essential oils create a safe environment at many levels. Erickson’s work led to the Modeling Theory,14 which requires building trust, promoting positive orientation, promoting strength, and setting mutual health-directed goals—these requirements also fit exceptionally well with aromatherapy. Rogers’s theory suggests that human beings are more than just physical entities and have specific energy fields. Aromas clearly affect both the psyche and the human energy field.
of nursing—putting the patient in the best condition for Nature to act—and thus aromatherapy clearly fits here because it allows the patient to relax sufficiently for the healing process to occur from within.13 Nightingale also suggested creating an environmental space conducive to healing—aromatherapy fits very well here as well, because essential oils create a safe environment at many levels. Erickson’s work led to the Modeling Theory,14 which requires building trust, promoting positive orientation, promoting strength, and setting mutual health-directed goals—these requirements also fit exceptionally well with aromatherapy. Rogers’s theory suggests that human beings are more than just physical entities and have specific energy fields. Aromas clearly affect both the psyche and the human energy field.
How Aromatherapy Works
The term aromatherapy refers to the therapeutic use of essential oils—the volatile organic constituents of plants. Essential oils are thought to work at psychological, physiologic, and cellular levels. This means that they can affect our body, our mind, and all the delicate links in between. The effects of aroma can be rapid, and sometimes just thinking about a smell can be as powerful as the actual smell itself. Take a moment to think of your favorite flower. Then, think about a smell that makes you feel nauseated. The effects of an aroma can be relaxing or stimulating depending on the previous experience of the individual (called the learned memory), as well as the actual chemical makeup of the essential oil used.
Who Uses Aromatherapy?
Aromatherapy is used by nurses in the United Kingdom, France, Germany, Switzerland, Sweden, Australia, New Zealand, Korea, and Japan. In France and Germany, medical doctors and pharmacists also use aromatherapy as part of conventional medicine, often for the control of infection. Aromatherapy is the fastest growing therapy among nurses in the United States.6
Although essential oils are very safe to use, there are some guidelines that need to be followed. Reference-backed, patient-centered clinical training is strongly recommended (see www .rjbuckle.com for classroom or home study courses). See Exhibit 25-2 for relevant warnings, contraindications, and precautions. Possible drug interactions are listed in Exhibit 25-3.
Adverse Reactions
There is some evidence of adverse skin reactions caused by sensitivity in rare instances. The majority of cases were from extracts rather than pure essential oils. Bergamot used in conjunction with sunshine or tanning beds can result in skin damage ranging from redness to full-thickness burns.15 It is recommended that essential oils should be used with caution during pregnancy, although the risk is extremely small when the essential oils are used only topically or inhaled; however, sage, pennyroyal, camphor, parsley, tarragon, wintergreen, juniper, hyssop, and basil should be avoided.16 Tisserand and Balacs state that there is “no evidence that essential oils are abortificient in the amounts used in aromatherapy.”17
Administration
Essential oils can be used topically or inhaled. A typical topical application uses a 1-5% mixture: 1-5 drops of essential oils diluted in 5 cc (a teaspoon) of cold-pressed vegetable oil such as sweet almond oil. Some wound infections may require higher concentrations—up to 20%. Certain essential oils, such as lavender and tea tree, can be topically applied undiluted for stings or bites. Others, like clove and thyme, should never be used undiluted on the skin because their high phenol content would cause burning. For insomnia, nausea, or depression, the client should inhale the correct oil for 5-10 minutes as necessary. The nurse can use touch methods such as massage or the ‘M’ Technique where appropriate. Simple stress management can be incorporated into an everyday regime with the use of baths and foot soaks, vaporizers, and sprays. Oral intake of essential oils, while extremely effective for acute infection or gastrointestinal problems, is not recognized as part of holistic nursing care at this time.
Self-Help
Aromatherapy can be very useful when self-applied for stress management, insomnia, or depression because the oils are portable and can be used anywhere at any time. A drop of peppermint can help clear your mind at the end of
a busy day, or a drop of ylang ylang can help soothe nerves. It is simple to choose an essential oil that is pleasing as well as efficacious.
a busy day, or a drop of ylang ylang can help soothe nerves. It is simple to choose an essential oil that is pleasing as well as efficacious.
EXHIBIT 25-2 Warnings, Contraindications, and Precautions When Using Essential Oils
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TABLE 25-2 Essential Oils Distributors Used by the Author | |||||||||||||||||||||||||||
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EXHIBIT 25-3 Drug Interaction When Using Essential Oils
Avoid strong aromas such as peppermint and eucalyptus with patients receiving homeopathy.
People who are allergic to ragweed may be allergic to chamomile.
The effect of tranquilizers, anticonvulsants, and antihistamines may be slightly enhanced by sedative essential oils.
Credentialing
At the moment there is no recognized national certification for aromatherapy. The closest thing is the Aromatherapy Registration Council (ARC) exam set by the Aromatherapy Registration Board (ARB), a nonprofit entity that provides a national exam for lay people (www .aromatherapycouncil.org). Details of the exams are available from the website. The exam is open to anyone who has studied aromatherapy for 200 hours and meets the criteria. There is little, if any, clinical content in the exam. There are two professional bodies: the National Association of Holistic Aromatherapy (NAHA) and Alliance of International Aromatherapists (AIA). At present, there are no requirements to become certified or accredited, and aromatherapy training can range from 1 day to several years. However, because nurses are accountable, if a nurse wants to use aromatherapy in his or her nursing care, it is strongly recommended that he or she be able to show documented evidence of clinical training, preferably one that is nurse taught and patient centered. Please see the AHNA website for endorsed and approved aromatherapy courses for nurses (www.ahna.org).
Aromatherapy for Dementia
Lin et al. conducted a cross-over randomized trial on 70 Chinese older adults with dementia.18 Half the subjects were randomly assigned to the active group (lavender inhalation) for 3 weeks and then switched to the control group (sunflower inhalation) for another 3 weeks; the other half did the opposite. Clinical outcomes were evaluated using the Chinese versions of Cohen-Mansfield Agitation Inventory (CCMAI) and Neuropsychiatric Inventory (CNPI). The mean CCMAI total scores decreased from 24.68 to 17.77 (t = 10.79, df = 69, p < .001). The CNPI scores changed from 63.17 (SD = 17.81) to 58.77 (SD = 16.74) (t = 14.59, df = 69, p < .001) after receiving Treatment A (Lavandula angustifolia). Also, Fowler shows aromatherapy could help crisis management during the night shift for adolescents in a residential treatment center.19
An in vitro study by Huang et al. in 2008 demonstrates that lavender essential oil reversibly inhibited GABA-induced currents in a concentration-dependent manner whereas no inhibition of NMDA- or AMPA-induced currents was noted.20 Lavender essential oil elicited a significant dose-dependent reduction in both inhibitory and excitatory transmission, with a net depressant effect on neurotransmission (in contrast to the classic GABA[A] antagonist picrotoxin, which evoked profound epileptiform burst firing in these cells). Lavender is commonly used to relax and soothe patients with dementia.
Five R. J. Buckle students chose to do their research projects on dementia between 1999 and 2003. The most common essential oil chosen was lavender, but there were also good results from mandarin and frankincense. Sadly, none of the studies has been published.
Aromatherapy for Pain
Previous studies using aromatherapy for pain suggest that both inhaled and topically applied essential oils may affect the perception of pain. More recent research indicates that some essential oils might have analgesic properties. Also, aromatherapy uses touch, particularly the ‘M’ Technique, and this technique has profound effects on chronic pain on its own, which are enhanced with essential oils. Please see Case Study 2 on chronic pain later in this chapter.
In 2006, Han et al. found a mixture of essential oils topically applied to the abdomen of 67 nurses had a statistically significant effect on reducing menstrual pain.21 This randomized, placebo-controlled study is one of several exciting studies carried out by nurses to come out of Korea. The essential oils used were Lavandula angustifolia, Salvia sclarea, and Rosa centifolia. Subjects were nurses who rated their pain less than 6 on a 10-point visual analog scale and who did not use contraceptive drugs. Kim et al. explored the use of 2% lavender oil inhaled immediately postoperatively in a randomized, controlled study of 50 patients undergoing breast biopsy surgery.22 A visual analog score (0-10) was used at 5, 30, and 60 minutes postoperatively, as well as patient pain satisfaction scores and time required to discharge from the postanesthesia care unit. It is strange that such a low percentage was used for inhalation
(2%)—normally full-strength essential oil is used— and hardly surprising that pain scores were not affected. However, subjects did report a higher satisfaction pain control rate in the lavender group. Perhaps it might have been simpler to have evaluated the difference in “comfort.” This was the outcome measure in a study by Nord looking at promoting comfort in pediatric perianesthesia.23 She used lavender and ginger on 91 patients: the control group received a nonactive vegetable oil with a slight aroma (jojoba). The mean distress was lower for the experimental group.
(2%)—normally full-strength essential oil is used— and hardly surprising that pain scores were not affected. However, subjects did report a higher satisfaction pain control rate in the lavender group. Perhaps it might have been simpler to have evaluated the difference in “comfort.” This was the outcome measure in a study by Nord looking at promoting comfort in pediatric perianesthesia.23 She used lavender and ginger on 91 patients: the control group received a nonactive vegetable oil with a slight aroma (jojoba). The mean distress was lower for the experimental group.
Aromatherapy for Infection
There is considerable published research available on the in vitro antibacterial, antifungal, and antiviral effects of a great number of essential oils. A search on Medline using the botanical name of the individual aromatic plant coupled with the term essential oil produces between 20 and 100 papers per essential oil.
The world is experiencing a soaring increase in resistant infections. Methicillin-resistant Staphylococcus aureus (MRSA) has become endemic.24 Even vancomycin, often used to treat MRSA, has shown disappointing cure rates: 44% failure in treating bacteria and 40% failure in treating lower respiratory tract infections.25 Some antifungal drugs are no longer working,26 and some antivirals are no longer effective.27
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