Help Patients Breathe Easier

The patient at John Muir Hospital was extremely anxious while waiting for her surgery to start and had no loved ones present to support her, which the pre-op nursing staff knew would only intensify her anxiety. Thomas Koehler, BSN, RN, CNOR, a perioperative nurse at the facility in Walnut Creek, Calif., gave the patient a plastic inhaler about the size of a lipstick container filled with calming lavender oil. “The patient used the inhaler frequently, almost like a calming blanket,” says Mr. Koehler. “She told us the inhaler helped her relax, which in turn made me feel good. I think a lot of pre-op nurses feel helpless because there really aren’t a lot of things in our toolkit that treat acute preoperative anxiety.”

That’s precisely why aromatherapy is so valuable. It’s inexpensive, safe and effective for many. Mr. Koehler notes that studies have shown that between 60% to 90% of patients can experience pre-op anxiety and that it can be particularly prevalent in female patients. Furthermore, many patients cite the anxiety as the worst part of their overall surgical experience and the stress can in some cases be linked to poor post-op physiological outcomes.

“Yes, medications are available to help calm patients, but they require a physician’s orders and sometimes the anxiety doesn’t fully present itself until shortly before a procedure,” says Mr. Koehler. “It’s important that we do everything we can to address a condition that’s so common and can negatively impact patients’ health.”

Mr. Koehler oversaw a study at Muir Hospital that included 44 surgical patients — 29 women and 15 men. The participants were asked to rate their anxiety before using the inhalers, and after they used them as needed for at least 20 minutes. Twenty-three of the patients, just more than half, reported a reduction in anxiety after receiving the lavender aromatherapy. Mr. Koehler says the women in the study seemed to benefit from the intervention more, as they reported higher pre-aromatherapy anxiety levels than men but about the same anxiety levels after using the inhalers, meaning they experienced a larger anxiety reduction.

Some of the study’s participants already used lavender oil inhalers to help them sleep, during massages or in meditation practices. This might have led to a bias in the study’s results, according to Mr. Koehler, but he says it also points to the benefits of involving patients in their own care. He notes patients expressed appreciation that a calming measure that has worked in other parts of their lives was offered to them before their high-stress surgery.

Using essential oils to calm patients is also good for facilities and staff. “Aromatherapy is a low-cost, effective and safe treatment that benefits hospitals, consumers and nurses alike,” says Mr. Koehler.

It’s empowering for perioperative nurses, as well. They can administer aromatherapy autonomously along with traditional medications and without the permission of physicians. That gives them more options to immediately help the patients in their care.

Mr. Koehler thinks the use of aromatherapy is an example of how perioperative nurses in the field can trial safe and inexpensive evidence-based interventions that could create future protocols that have the potential to improve patient outcomes and experiences.

Anxiety medications are rarely used at Einstein Endoscopy Center in Blue Bell, Pa., and the endoscopies and colonoscopies performed there don’t produce nausea or vomiting postoperatively. But Adrienne Bellino-Ailinger, BSN, JD, RN, HNB-BC, CPHQ, the facility’s performance improvement specialist, saw that even routine screening procedures can produce anxiety in patients.

Aromatherapy is inexpensive, and a very easy way to put nervous patients at ease.
— Thomas Koehler, BSN, RN, CNOR

Ms. Bellino-Ailinger, a certified holistic nurse, wanted to bring pre-op aromatherapy to her patients’ bedsides. Knowing that current research shows a growing desire for patients to receive holistic treatment approaches, she applied for and received an Albert Einstein Society grant to study the benefits of aromatherapy on pre-op anxiety.

The grant was awarded in 2019 and began in 2020, but the study remains incomplete because it was interrupted by the pandemic. The facility was shut down for several weeks and Ms. Bellino-Ailinger, the study’s principal investigator, determined that patients wearing masks is too big of a variable for the study to overcome. Before the study was suspended, however, 29 patients participated. Fifteen were in the aromatherapy treatment group and 14 were in the control group.

“The interim analysis demonstrates that aromatherapy shows promise in decreasing anxiety in patients,” says Ms. Bellino-Ailinger. “We look forward to resuming it soon and sharing some good information with the community.”

The patients were given a compilation of bergamot sweet orange, YLang YLang and lavender oils delivered in a plastic container that was clipped onto their gowns. They were surveyed about their anxiety levels twice — once before they were admitted and again after they had been prepped for their procedures and had the opportunity to inhale the oils.

“Anytime we can avoid using a medication and steer clear of its potential side effects, we try to do it,” says Ms. Bellino-Ailinger. “Medications should be used when necessary, and complements such as aromatherapy should coexist with them.” OSM

Note: This three-part article series is supported by Soothing Scents.