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Nursing Work Related Stress in the ICU and Aromatherapy
Page 4 Nursing work related stress in the ICU and Aromatherapy
Sandra Hubbard, BSN, RN, TCRN - 2020 Nursing Research Fellowship
Background
Due to the dynamic nature of their work environments, ICU nurses are at substantial risk of experiencing negative sequelae of anxiety. Nurses with higher resilience and a larger arsenal of coping mechanisms may be better able to cope with work-related stress and may be less likely to experience symptoms of anxiety. One potential coping strategy is aromatherapy. Existing knowledge regarding use of aromatherapy suggests a relationship between aromatherapy and reduced nurse stress and anxiety.1-16 However, the number and quality of studies is limited, supporting the need for further research.7 The purpose of this research study was to explore in ICU registered nurses, what is the effect of an inhaled aromatherapy blend containing lavender, bergamot, sweet orange, and ylang-ylang compared to placebo on perceptions of work-related state anxiety over a 30-day period?”
Design
This was an IRB approved randomized, blinded, placebo-controlled study with a quantitative (experimental) design.
Study objectives were the following:
This study used a convenience sample of RNs, 18 years and older, whose primary work locations were select ICUs at Carilion Roanoke Memorial Hospital (CRMH) and the ICU at Carilion New River Valley Medical Center (CNRV). Exclusion criteria included self-reported asthma or history of reactive airways, allergies to any components of the selected study aromatherapy blend or placebo - lavender, bergamot, sweet orange, ylang-ylang, normal saline, being pregnant, potentially pregnant or planning to become pregnant in the next 90 days or nursing, or a history of skin or respiratory reactions to inhalation of an essential oil.
Methods
Potential subjects were recruited through email via the secure platform REDCap. After the research coordinator consented potential subjects, a pre-intervention survey consisting of demographic information and the State-Trait Anxiety Inventory for Adults (STAI-A) was completed via REDCap. The study biostatistician randomized the consented subjects to either the placebo or intervention group. To maintain blinding, the research coordinator distributed the aromatherapy delivery devices. The intervention device was a personal wick shaped inhalation device with an aromatherapy blend composed of high-quality essential oils including lavender, bergamot, sweet orange, and ylang-ylang. The placebo device was a personal disk-shaped inhalation device containing normal saline. At the conclusion of the 30-day intervention period, subjects took a post-survey consisting of the same STAI-A and completed a device use questionnaire.
Findings
Twenty-three nurses completed the pre-surveys, with 18 completing the post-surveys. To conduct paired t-test analysis, data from the five nurses not completing the post-surveys was excluded from data analyses. Ten nurses participated in the intervention group and eight in the placebo group. Sample characteristics are summarized in Table 1.There were no statistically significant differences in the demographic characteristics between the intervention and placebo groups.
Results: STAI mean differences within paired intervention and placebo samples did not meet statistical significance (p≥0.05). A reduction in the paired trait anxiety mean scores in the placebo sample from pre 38.875 to post 33.625 approached significance at 0.0586. There were no statistically significant differences between the intervention or placebo group mean pre or post STAI scores (p≥0.05). Results are summarized in Tables 2 and 3.
Results: Regression analysis was not conducted due to the absence of statistically significant findings in bivariate analyses
Implications for Practice
This study is the first randomized blinded placebo trial to investigate the impact of an inhaled aromatherapy intervention versus placebo on ICU nurse anxiety. Although there is limited published data on normative registered nurse anxiety scores measured with the STAI, recent literature suggests scores between 40-59 are indicative of moderate anxiety in adults.17 The mean state and trait anxiety scores for the nurses in this study ranged between 33.625 and 44.3 with standard deviations ranging between 7.6146 to 11.7. These scores suggest moderate anxiety levels in the study sample similar to those reported in prior nurse studies, supporting the need for identification of effective resilience strategies for nurses in the ICU setting.
Most prior studies support a relationship between aromatherapy and reduced nurse stress and anxiety; however, not all studies demonstrated direct linkage to reduced stress or anxiety. This study did not demonstrate significant differences in state or trait anxiety levels pre to post intervention within study groups or between intervention and placebo groups; however, the study sample size was insufficient to achieve power. Conducting a study during a pandemic, even a study designed to reduce anxiety, could have been a factor in our recruitment efforts and may have impacted STAI scores.
An important study finding is that use of an aromatherapy intervention inhalation device can be used by ICU nurses safely in the clinical setting without any reported untoward impact. On average, subjects in this study used their inhalation device 15 times during the 30-day study period and only one subject reported scent was noted by a bystander. These findings are consistent with prior research demonstrating aromatherapy interventions can be safely implemented in the clinical setting.9, 11
Conclusions
There is a dearth of research on the impact of aromatherapy on nurse anxiety in the clinical setting in general and, specifically, in the ICU setting. This study, as the first randomized blinded placebocontrolled study in the ICU setting, serves as a pilot to explore the impact of aromatherapy on anxiety in ICU registered nurses. The study supports additional research is needed to evaluate the impact of aromatherapy on reduction of nurse anxiety in a variety of settings.
References
1. Eren, N., Oztune, G., (2017). The effects of aromatherapy on the stress and anxiety levels of nurses working in
Intensive Care Units. International Journal of Caring Sciences,10(3), 1615-1623. 2. Roberts, R. & Grubb, P. (2013). The consequences of nursing stress and need for integrated solutions.
Rehabilitation Nurse, 39(2), 62-69. doi: 10.1002/mj.97. 3. Rushton, C., Batcheller, J., Schroeder, K., & Donohue, P. (2015). Burnout and resilience among nurses practicing in high-intensity settings. American Journal of Critical Care,24(5), 412-420. doi: 10.4037/ajcc2015291. 4. Johnson, K., West, T., Diana, S., Todd, J., Haynes, B., Bernhardt, J., & Johnson, R. (2017). Use of aromatherapy to promote a therapeutic nurse environment. Intensive & Critical Care Nursing, 40(1), 18-25. doi: 10.1016/ j.iccn.2017.01.006. 5. Johnson, C. (2019). Effect of inhaled lemon essential oil on cognitive test anxiety among nursing students. Holistic
Nursing Practice, 33(2), 95-100. doi: 10.1097/hnp.0000000000000315 6. American Holistic Nurses Association. www.ahna.org. (2019). Accessed 2019. 7. Li, H., Zhao, M., Shi, Y., Xing, Z., Li, Y., Wang, S., Ying, J. … Sun, J. (2019). The effectiveness of aromatherapy and massage on stress management in nurses: A systematic review. Journal of Clinical Nursing, 28(3/4), 372-385. doi: 10.111/jocn.14596. 8. Chen, M., Fang, S., Fang, L., (2015). The effects of aromatherapy in relieving symptoms related to job stress among nurses. International Journal of Nursing Practice, 21(1), 87-93. doi:10.1111/ijn.12229. 9. Pemberton, E. & Turpin P. (2008). The effect of essential oils on work-related stress in intensive care unit nurses.
Holistic Nursing Practice, 22(2), 97-102. 10. Zamanifar, S., Bagheri-Saveh, M. I., Nezakati, A., Mohammadi, R., & Seidi, J. (2020). The effect of music therapy and aromatherapy with chamomile-lavender essential oil on the anxiety of clinical nurses: A randomized and double-blind clinical trial. Journal of Medicine & Life, 13(1), 87–93. https://doi-org.lib-proxy.radford.edu/10.25122/jml2019-0105. 11. Han, X., Gibson, J., Eggett, D., & Parker, T. (2017). Bergamot (citrus bergamia) essential oil inhalation improves positive feelings in the waiting room of a mental health treatment center: A pilot study. Phytotherapy Research, 31 (1), 812-816. doi: 10.1002/ptr.5806. 12. Donalson, J., Ingrao, C., Drake, D., Ocampo, E., (2017). The Effect of Aromatherapy on Anxiety Experienced by
Hospital Nurses. Medsurg Nursing, 26(3), 201-206. 13. Cooke, M., Holzhauser, K., Jones, M., Davis, C., Finucame, F. (2007). The effect of aromatherapy massage with music on the stress and anxiety levels of emergency nurses: Comparison between summer and winter. Journal of
Clinical Nursing,16(9), 1695-1703. doi:10.1111/j.1365-2702.2006.01709x. 14. Hongratanaworakit, T., Buchbauer, G. (2004). Evaluation of the harmonizing effect of ylang-ylang oil on humans after inhalation. Planta Med. 70:632-636. 15. American Psychological Association. (2020). Anxiety. Retrieved from apa.org/topics/anxiety 16. Hume, L. (2018). An investment in staff well-being, Nursing Management. Springhouse. 49(12), 9-11 doi: 10.1097/01.NUMA.0000547833.17955.8a . 17. Akinci, A., Keles, F., & Savci, C. (2021). Anxiety levels and clinical decision-making skills of nurses providing care for patients diagnosed with COVID-19. Electron Journal of General Medicine, 18(6):em22. https:// doi.org/10.29333/ejgm/11300.
