17 (Part II) Aromatherapy within the National Health Service
Part 2 shows how the use of aromatherapy is now being integrated into clinical settings and how codes of professional conduct for nurses can also be applied to aromatherapists. It gives guidelines for administering medicines and outlines how to write a policy, followed by a draft example of a protocol, which aromatherapists will find useful.
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).
Aromatherapy is a multiple therapy embracing touch, massage and the administration of essential oil remedies – not to mention the accompanying pleasing aroma, which may be partly responsible for its being possibly the most popular complementary therapy nurses wish to study. There have therefore been increasing demands that, in the best interests and safety of patients and clients, complementary therapies should become regulated and observe similar ethical and practical constraints to those of orthodox medicine.
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.
Although there was concern about the lack of scientific evidence – as measured by random controlled trials (RCTs) – the report recognized that there was a growing body of qualitative research. The therapies most frequently used by nurses and midwives, such as massage, aromatherapy and reflexology, come within the ‘comfort’ category. The RCN survey in 2003 confirmed that these were the key therapies used in clinical practice.
The House of Lords report also encouraged the regulating and professional bodies – Nursing and Midwifery Council (NMC) and Royal College of Nursing (RCN) – to collaborate in making familiarization of CAM a part of the pre-registration nursing and midwifery curricula, which would enable nurses and midwives to have some insight into the choices that their patients or clients make and to offer knowledgeable support. The report went on to suggest that these bodies should provide specific guidance on appropriate education and training for nurses and midwives who wish to integrate therapies such as aromatherapy into clinical care.
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).
Successful regulation depends on increasing the research base of a profession, but recent academic hostility from science faculties has resulted in the closure of many leading complementary therapy degree courses, including degrees or diplomas leading to aromatherapy qualifications, e.g. those at the Universities of Westminster and Central Lancashire. With a diminishing research base, complementary therapies, including aromatherapy, will be less able to maintain the confidence of the public and orthodox healthcare.
There are key principles of professional practice that must be considered before integrating any complementary therapy into clinical care. These involve the following and can be found in policies that have already been developed:
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.
As there is no national strategy to collect data, professionals have to rely on publications in journals that describe the use of complementary therapies within the various health fields. A small proportion of these are based on research projects, but most are anecdotal.
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:
Aromatherapists and nurses should acknowledge any limitations in their knowledge and competence and decline duties or responsibilities they cannot perform in a safe and skilled manner. Suitable insurance to cover specific use of essential oils is essential. RCN members are covered when working as a nurse; however, when working independently cover can be obtained from one of the professional aromatherapy or aromatic medicine associations on becoming a full member. The International Federation of Professional Aromatherapists (IFPA) and the Institute of Aromatic Medicine (IAM) also insure student aromatherapists during their time of study.
Nurses, midwives and health visitors using essential oils, whether for baths, inhalations, topical application (including compresses), suppositories, pessaries and/or massage, should accept that they are administering medicines, and recognize the personal professional accountability they bear for their actions.
Since 1992 medicinal preparations have been prescribed by a physician or nurse, checked and dispensed by a pharmacist and administered by a nurse. An essential oil prescription is prescribed by a competent aromatherapist or aromatologist and administered by that practitioner, or by a nurse suitably trained in its method of administration.
• 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.