Aromatherapy means more than fresh flowers in a vase
San Antonio hospices routinely use herbal scents
Hospices have a good opportunity to try an alternative medicine practice such as aromatherapy, because hospice staff focus entirely on symptom management.
"You can’t treat diseases with aromatherapy, but you can treat symptoms," says Irene Gilliland, MSN, RN, clinical nurse specialist, who also is an instructor at the University of the Incarnate Word in San Antonio.
Gilliland has provided aromatherapy training to nearly all of the hospices in San Antonio, and she uses aromatherapy in her work with AIDS-afflicted children with at Providence Home in San Antonio. She also gave a seminar on aromatherapy at the National Hospice Organization’s 20th Symposium and Exposition in Dallas last November.
"People think of aromatherapy as a feel good discipline’ because it uplifts moods and spirit and has some physiological effects as well," Gilliland says.
Gilliland trained in aromatherapy about five years ago through courses held by the American Holistic Nursing Association in Flagstaff, AZ. She also has an interest in herbal medications and teaches about herbs as a complimentary therapy. Gilliland has also taught Spanish translations of herbal remedies so the area’s large Hispanic population may learn more about them.
Aromatherapy sometimes can help patients when more standard treatment is not available, Gilliland suggests.
For example, when the Washington, DC-based Food and Drug Administration (FDA) removed the Scopalamine patch from the market after hospices had been using it to treat patients’ terminal secretions, some hospice nurses were without an easy alternative. About that time, Gilliland was traveling and met an English nurse whom she asked what they used to treat terminal secretions. The nurse told her they put juniper in an oil and rub patients’ feet with the mixture.
Gilliland returned home and decided to try a mixture of juniper, lemon, and frankincense. "I didn’t like the smell of juniper, so I combined it with lemon and frankincense," she says.
She chose frankincense because it has been used in various religious rituals for thousands of years, and to people who practice certain Eastern religions, it is believed to open the crown chakra, a doorway to a person’s higher being or spirit.
The foot rub also served two other purposes: One, it would allow the nurse or family member to rub portions of the patient’s feet that corresponded to the lungs, as in reflexology, and secondly, it would give the family a way to touch and connect with their dying loved one.
"It helps families with the helplessness they feel about the person who is dying," Gilliland says. "It gives them a way of connecting and makes it a very spiritual, sacred experience."
Sometimes the foot rubs mean so much to the family members that when Gilliland returned to pick up the scented oil, families would ask her if they could keep it because it reminded them of their deceased loved one.
And the oil, for whatever reason, appeared to work in reducing terminal secretions, she adds.
Gilliland offers these "recipes" for aromatherapies that may help relieve various symptoms for hospice patients:
To reduce terminal secretions: five drops of frankincense, five drops of juniper, and five drops of lemon placed in a sweet almond oil.
To relieve arthritis symptoms: Place a few drops of peppermint, black pepper, or wintergreen in a lotion or body oil, and apply to the area where the patient feels pain.
To reduce swelling: Juniper is a powerful diuretic. Nurses could use just a drop of juniper in 10 cc of a sweet almond oil or another type of oil and apply it to the swollen area. "One woman had swollen arms because of a bilateral mastectomy, and after putting juniper oil on her, she could use her hands again," Gilliland says. "Another case was a pregnant woman who couldn’t get her rings off and was going to have them cut off her fingers, so we put some juniper in sweet almond oil, and she could get her rings off."
For antibacterial purposes: Some hospice nurses have used aromatherapy to help patients with methicillin-resistant S. aureus (MRSA) infection. "A few hospice nurses have used them for bladder and wound irrigation of all kinds for people who are MRSA positive," Gilliland says. "There are about 25 oils that have been effective for MRSA, and tea tree is one."
For treating nausea: A little peppermint in oil may help.
For headaches: "The headaches I usually come across are caregiver headaches from caregiver strain," Gilliland says. "So I say, Just sit down and let me rub your neck and back,’ and I use one or two drops of peppermint in a carrier oil to help them with tension."
To treat itchy dry skin: Gilliland uses a type of lavender called angustifolia, which is a completely harmless herb that can be directly placed on the skin, or a person can bathe in it. If it’s rubbed over the dry area, she recommends the nurse place it in jojoba oil.
To treat itchy moist skin: "If the person’s skin isn’t dry, I put it in aloe vera gel." Gilliland once helped a hospice treat a patient whose legs were so dry that the patient had scratched them raw. The physician wanted to use a steroid cream, but the hospice suggested they first try some aromatherapy oils, so they did, and the patient’s skin cleared up.
Gilliland recommends that all nurses using aromatherapy, especially if it’s being used in oils that are directly applied to someone’s skin, first make sure the patient is not allergic to a particular herb.
For example, people who are allergic to Christmas trees might have a difficult time with juniper. And people who have ragweed allergies might not tolerate chamomile very well.
Hospice nurses typically will do a little swatch test of putting a dilute form of the herbal oil on the person’s skin and leave it there for 15 minutes before applying the aromatherapy treatment.
"We do that routinely, and so does every member of a hospice team, including the social worker and chaplain when they use aromatherapy oils," Gilliland says.
Another precaution has to do with citrus oils. If these are applied directly to a person’s skin then the person should avoid exposing those areas to the sun because they could form brown spots.
Aromatherapy also may be used without direct skin application. Some herbs may be placed in a diffuser or a couple of drops could be put on a light bulb or in a pot of boiling water. "Just smelling it helps," Gilliland says.
For example, inhaled frankincense may help protect people against viruses, which was how the herb was used thousands of years ago in Jewish temples, she adds.
Hospice nurses also typically ask the patient and family directly if they would be interested in aromatherapy, rather than seeking the physician’s advice. Some hospices have even invested in aromatherapy oils and training for their entire staff, Gilliland says.
For hospices that would like to learn more about aromatherapy, Gilliland recommends they read Aromatherapy for Health Care Professionals, written by Shirley Price and Len Price. The hardcover book is scheduled to be published in June 1999.
The Prices also have written a book called The Aromatherapy Workbook: Understanding Essential Oils from Plant to Bottle, published in May 1994 by Thorsons Publishers.
Sources
• American Holistic Nursing Association, P.O. Box 2130, Flagstaff, AZ 86003-2130. Telephone: (800) 278-AHNA.
• Irene Gilliland, MSN, RN, Instructor, University of the Incarnate Word, 4301 Broadway, San Antonio, TX 78209. Telephone: (210) 829-6029.
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