17 (Part II) Aromatherapy within the National Health Service
Development of complementary therapies
Many healthcare professionals are interested in exploring the potential therapeutic use of a range of complementary therapies, which are maintaining their popularity with the public (Thomas, Nicholl & Coleman 2001).
This continued interest has encouraged the use of CAM therapies in palliative care (Gage et al. 2009), midwifery (Mousley 2005) and nursing (Maddock-Jennings & Wilkinson (2004).
The House of Lords Report (2000) classified therapies according to their evidence base and level of professional organization in relation to regulation (see Part 1 and Table 17.1). with regard to nursing and midwifery, the report identified Group 2 as covering those therapies most often used to complement conventional care. It was felt that the therapies mentioned in this ‘comfort’ category gave appropriate help and support to patients, in particular in relieving stress and pain and alleviating the side effects of drug regimens.
Integration of aromatherapy is currently threatened on several fronts, involving regulation, financial constraints for both education and the NHS and academic hostility. The regulation process for aromatherapy has stalled because a number of professional bodies have chosen not to align themselves with the newly launched federal regulation body, supported by the Department of Health, the Complementary and Natural Healthcare Council. This will cause problems for nurses and other healthcare professionals who wish to advance the use of aromatherapy, as their employers will expect them to be members of a rigorous and transparent system – still having several ‘regulation’ bodies is confusing for NHS Trusts and the general public alike (Stone 2010).
The recession has meant that financial constraints on universities have seen many courses facing closure as priorities shift. Within the NHS financial cuts have meant that nurses have even less time to attend to their patients’ comfort and emotional needs – an area in which the use of massage and essential oils had demonstrated good possibilities (Hadfield 2001).
Integrating aromatherapy into clinical care
• patient-centred care – identifying patients’ needs or problems and the subsequent outcome of care
• appropriate choice of therapeutic intervention
• identification of the parameters of practice
• pinpointing the evidence supporting integration
• identification of the appropriate integration model
• ensuring education and training needs that will provide safe and effective practice
• the development of effective evaluation strategies and ongoing development needs that will support a sustainable service.
A policy for integration, based on evidence and a valid audit process (Mousley 2005), is essential, otherwise it is difficult to see how nurses and midwives can argue for integrating CAM into clinical practice, especially as therapies are often used as a result of enthusiasm on the part of one or two nurses or midwives. A number of Trusts have already allocated time and effort to developing policies, and it is by such work that standards are defined and patients are assured of care that is safe, appropriate and effective. The appropriate therapy is often determined by the nature of a particular clinical area. The area of cancer and palliative care is one in which national guidelines on the integration of complementary therapies have been published by the Foundation for Integrated Health (PWFIH 2003) (Tavares 2003) and offer a wealth of information, including models of good practice.
Nursing and Midwifery Council (NMC)
Code of professional conduct
Registered nurses, midwives and health visitors have to follow the NMC Code of Professional Conduct (CPC) (2008a), the Standards for Medicines Management (2008b) and Complementary Alternative Therapies and Homoeopathy (2009) and are personally accountable for their practice. Some of the following points would also be applicable to aromatherapy practitioners; all must:
• respect the patient or client as an individual
• obtain consent before giving any treatment or care
• protect confidential information
• cooperate with others in the team
• act to identify and minimize risk to patients and clients.
Standard for medicines management
• be based, whenever possible, on the patient’s informed consent and awareness of the purpose of the treatment
• be clearly written, typed or computer-generated and be indelible
• be dated and signed by the authorized prescriber
• not be for a substance to which the patient is known to be allergic or otherwise unable to tolerate
• clearly identify the patient for whom the medication is intended
• clearly specify the substance to be administered, using the generic or brand name (in the case of aromatherapy the scientific plant name/s should be used), together with the strength, dosage, timing, frequency of administration, start and finish dates and route of administration.