Using aromatheraphy within nursing: nurses wanting to incorporate aromatherapy into their practice must overcome a number of challenges before using this powerful yet gentle therapy.

AROMATHERAPY--THE science and art of healing with essential oils--is a relatively new term, first coined by French chemist Rene Maurice Gatefosse in 1937. These oils have been used over thousands of years in many ancient civilisations. For example, inscriptions of aromatic formulae have been found on ancient Egyptian papyrus manuscripts, dating back to 2800 BC. (1) Popularity and interest in the complex and potent phytochemicals found in the essential oil of aromatic plants and their ability to effect healing continues to grow. Aromatherapy, along with massage, has become the most common of the complimentary therapies used by nurses in their clinical practise. (2)

My study in aromatherapy began around three years ago, prompted by a strong desire to learn more about the use of essential oils and natural therapies. I began by enrolling in a six-month, part-time certificate of aromatherapy course at Auckland's Wellpark College of Natural Therapies. I quickly came to realise that aromatherapy was more than a nice smell, that it was a powerful yet gentle therapy that required more than just a brief introduction to practise safely. After completing the certificate course, I realised I needed to train at diploma level if I was to practise as an aromatherapist or contemplate its use within nursing. The diploma course can either be undertaken full-time for a year or part-time over two and a half years. I chose the latter. The training was thorough, with a large component on essential oils and their application. The syllabus included modules on anatomy and physiology, applied anatomy, massage, lymphatic drainage, nutrition and aspects of other natural therapies, including herbal medicine, acupressure and ayurveda. Students must complete 100 hours in clinical practice to qualify.

There is much debate on how aromatherapy works, and equal debate as to how it should be used. (3) Practitioners believe the essential oils act holistically to provide physiological, psychological and spiritual effects. This article on the methods of aromatherapy administration is confined to olfaction and topical application only.

It is estimated that more than a million molecules are taken in with each breath. Essential oils produce a complex mixture of molecules, each conveying a chemical message. With inhalation, aroma is perceived via the olfactory tract to the olfactory centre of the brain where it connects with the limbic system. This sends further messages through to the hippocampus, amygdala and sensory areas. Analysis occurs at this point before messages are relayed to the hypothalamus affecting higher centres in the brain. (4) This application of essential oils by inhalation can be compared with intranasal drug delivery. (3) The power of this mechanism has been shown in research done in the United States (US) in 1999 where inhalation of aroma influenced both mood and pain in female subjects. (5)

Topical application refers to two processes: first, penetration into the skin and second, permeation transdermally into the small capillaries of circulation to produce a systemic effect. This method of application is similar in principle to the use of patch therapy for the delivery of drugs transdermally. (3)

There are a number of challenges to using aromatherapy in nursing. New Zealand aromatherapist and nurse Wendy Maddocks lists these as competency to practise, approval by your employer, vicarious liability and professional indemnity insurance, informed consent, accountability and legislative requirements. (6) Of primary concern is the need for adequate knowledge and training in safe and responsible use of aromatherapy. Minimal training must not be considered adequate for the therapeutic use of essential oils. Policies and protocols need to be in place, along with consent of medical practitioners and the patients themselves.

While research does exist on the clinical use of aromatherapy in nursing, its use within nursing is still in its infancy. Nurse, aromatherapist, author and academic now working in the US, Jane Buckle, suggests a major research movement is needed to provide evidence of clinical efficacy within nursing practice. (3) This remains an important issue for nurses wishing to integrate complementary therapies in nursing.

As a graduate of the aromatherapy diploma programme, I am aware of the tremendous worth and resource aromatherapy affords nurses in the care of their patients. There can be significant value when it is used as an independent therapy or complementary to conventional medicine. It allows nurses to extend and further promote holistic practice. I appreciate the experience of training in a modality that, while ancient in origin, provides a pioneering route among nurses as health care continues to re-evaluate and redefine itself in the 21st century. As nursing's mentor Florence Nightingale once wrote: "The cure is in caring."

REFERENCES

(1) Godalla, M. (1996) Historical Deception: the Untold Story of Ancient Egypt. Tehuti Research Foundation. Pennsylvania: Bastet.

(2) Maddocks W. (1994) The good oil. Nursing New Zealand; 2: 1, 10-12.

(3) Buckle J. (1997) Clinical Aromatherapy in Nursing. New York: Hillcrest Press.

(4) Price S., Price L. (1999) Aromatherapy for Health Professionals. 2nd Ed, Edinburgh: Churchill Livingstone.

(5) Marchand S., Bonapace J. and Pepin C. (1999) The role of olfaction in mood and pain perception. Soc Neurosci Abstr, 23: 2353.

(6) Maddocks W. (1999) Onus on nurses to practise safely. Kai Tiaki Nursing New Zealand; 5: 7, 16-17.

--Paula Haines, RCpN, Dip Aromatherapy, works part-time in surgical services at Auckland Hospital, is a clinical aromatherapist for the Auckland Cancer Society and runs an aromatherapy private practice.