Essential Oil Therapy for Alleviation of Discomfort in Surgical Patients

Practice Problem: Post-surgical pain (PSP) has not been sufficiently managed despite routine opioid use. The adverse effects of opioids led to the search for non-pharmaceutical intervention. PICOT: The PICOT question that guided this project was, "In an acute hospital surgical setting, does essential oil therapy complement pain and discomfort relief comparing to conventional pain management alone after 6 weeks?” Evidence: Seven clinical studies, five systematic or integrative reviews, and four conference proceedings were reviewed. The evidence supported lavender essential oil for the alleviation of PSP and discomfort. Intervention: Patients breathe through a personal lavender essential oil inhaler hourly or every 2 hours. Outcome: The percentage means of pre and post-intervention pain score reduction were 39.5117.73 and 45.7719.45. The post-intervention group's mean pain score changed from 51.53 to 27.71 pre and post-opioids. Opioid usage per patient day in two groups was 26.2 mg and 48.6mg in morphine equivalent. Pain scores pre and post essential oil therapy were 6.13 and 2.7. Conclusion: This project did not confirm the statistical significance of pain score reduction but a higher reduction in the post-intervention group. The results were clinically meaningful to offer lavender essential oil to alleviate PSP and discomfort. ESSENTIAL OIL THERAPY FOR SURGICAL PATIENTS 4 Essential Oil Therapy for Alleviation of Discomfort in Surgical Patients Post-surgical pain (PSP) has been a perennial challenge for healthcare providers. Various pharmaceutical drugs, including opioids, are prescribed and administered as a standard of care for PSP relief (Gan, 2017). The subsequent prolonged prescription opioid overuse or misuse has become a secondary concern (Stratton, Palombi, Blue, & Schneiderhan, 2018). The opioid crisis called for pain treatment options that have fewer side effects. As a result, complementary therapies have been advocated to be a part of individualized pain management strategies (Henningfield, Ashworth, Gerlach, Simore, & Schnoll, 2019). The Joint Commission (TJC) requires that at least one non-pharmaceutical therapy be offered for problematic symptoms and encourages the exploration of a variety of therapies. Aromatherapy is a significant complementary therapy because "it is easy to understand, as many of today's drugs originally came from plants" (Buckle, 2013, p. 564). The Massachusetts Board of Registration in Nursing was the first state board to accept complementary therapy as part of a "holistic model of nursing" and "within the scope" of nursing (Buckle, 1998, p.58). The California Board of Registered Nursing (2000) supports the registered nursing role in providing complementary, alternative therapies as nursing's holistic tradition. Lavender essential oil has been demonstrated in the literature as an effective complementary therapy for PSP (Gorji et al., 2015; Hasanzadeh et al., 2015; Kim et al., 2007; Yu & Seol, 2017). This evidence-based practice (EBP) project was to assess the implementation of lavender essential oil therapy (interchangeable as aromatherapy) as a non-pharmaceutical therapy for alleviating discomfort in surgical patients. The EBP intervention included a training module for nurses working on a post-surgical floor and the implementation of an aromatherapy protocol. Evaluation of aromatherapy implementation was measured by auditing electronic health records ESSENTIAL OIL THERAPY FOR SURGICAL PATIENTS 5 (EHR) to collect pain scores and opioid use per patient per day in morphine equivalents and collecting nurse self-efficacy surveys (paper based) pre, post, and 4 weeks after training. The project was conducted at an acute community hospital in Sacramento, California, on the Acute Surgical Unit (ASU). The primary content areas discussed in this report are the significance of the practice problem, PICOT question, theoretical framework, synthesis of literature review, and practice recommendation. Additionally, the project implementation process is discussed, which include the project setting and overview, project plan, evaluation plan, discussion and implication for nursing and healthcare, dissemination, and conclusion. Significance of the Practice Problem Pain is a significant symptom that hospitalized surgical patients experience despite routine pharmaceutical intervention. Johnson et al. (2016) noted that every group of hospitalized patients have a certain level of pain or risk for pain. Several studies nationally and globally reported a prevalence of PSP: 80% in the U.S., 30% in India, and 50% in Italy (Gan, 2017; Harsoor, 2011; Sansone et al., 2015). In the project hospital, Healthgrade's (2019) report showed that the hospital scored 3% lower than the 68% national average in providing adequate pain relief. Suboptimal or inadequate PSP relief may "result in clinical and psychological changes that increase morbidity and mortality," or cause "impaired quality of life, slowed recovery, prolonged opioid use, and increased cost of care," or "negative physiological and psychological outcomes" (Gan, 2017, p. 2288; Gorgi et al., 2015, Introduction section; Harsoor, 2011, p. 101; Sansone et al., 2015). While care providers are obligated to provide adequate pain relief, prescribing addictive opioids for pain relief should be weighed against the risk of abuse or misuse (Kotalik, 2012). The current opioid crisis has led to an ethical dilemma and inadequate pain control ESSENTIAL OIL THERAPY FOR SURGICAL PATIENTS 6 (Stratton et al., 2018). Data from 2016 showed more than 42,249 overdose fatalities (The New Opioid Problem, 2018, The Scope and Response section). The TJC sets pain management as a standard of quality and requires hospitals to “provide at least one non-pharmacological pain treatment modality" (2018, para. 1). Therefore, healthcare providers' responsibility is not only to offer adequate pain control but also to limit the risk of overuse and addiction to opioids. Aromatherapy can be a safe addition to current pain management with no adverse effects (Lakhan, Sheafer, & Tepper, 2016).