The Effects of Aromatherapy on Intensive Care Unit Patients' Stress and Sleep Quality: A Nonrandomised Controlled Trial

The effect of lavender and bergamot oil applied via inhalation on the anxiety level and sleep quality of surgical intensive care unit patients

OBJECTIVE

Due to numerous stressors in intensive care, common psychosocial problems arise in patients. Among these, decreased anxiety and sleep quality are observed. This study aims to determine the effect of lavender and bergamot oil applied by inhalation on anxiety and sleep quality in surgical intensive care unit patients.

METHODS

Fifty-four patients hospitalized in the intensive care unit of a hospital in Istanbul, Turkey, were included in this study. They were randomly divided into three groups (Lavender, Bergamot, Control). Intervention groups were exposed to 3 drops of lavender oil or bergamot oil on pillows for 20 min, which were then placed 10 cm away from the patient's head. This intervention was applied for two nights. The patients' sleep quality and anxiety level were evaluated using the "State-Trait Anxiety Inventory (STAI)" and "Richard-Campbell Sleep Scale (RCSS)." Data were analyzed using Chi-square, independent t-test, One-way ANOVA tests.

RESULTS

According to our results, anxiety scores significantly decreased in the lavender and bergamot groups. Sleep quality scores significantly increased (p = <0.001). The control group showed lower sleep quality scores.

CONCLUSION

Lavender and bergamot oil inhalation appeared effective in reducing anxiety and improving sleep quality in surgical intensive care unit patients.

Stress and sleep quality in palliative care

OBJECTIVES

Palliative care patients experience problems in sleep quality due to stress, chronic diseases, and physical and psychosocial problems. Our aim is to determine the perceived stress and sleep quality levels of our palliative care patients and their related factors.

METHODS

This cross-sectional, descriptive research was conducted between November 2023 and February 2024 at a palliative clinic located in Ankara, Turkey, that is affiliated with a training and research hospital. In the research, a data form, the Perceived Stress Scale and the Pittsburgh Sleep Quality Index were used as data collection instruments. Kolmogorov-Smirnov and Shapiro-Wilk tests, and Mann-Whitney U and Kruskal-Wallis H tests were used for the analysis.

RESULTS

The total score on the Perceived Stress Scale was determined to be 35.81±7.45. The total score for Pittsburgh Sleep Quality Index was 13.20±3.20. Significant relationships were found between insufficient self-efficacy scores and habitual sleep efficiency, daytime dysfunction and total Pittsburgh Sleep Quality Index scores. Significant relationships were found between insufficient self-efficacy scores and sleep latency, habitual sleep efficiency, daytime dysfunction and total Pittsburgh Sleep Quality Index scores.

CONCLUSIONS

This study determined that certain descriptive characteristics of palliative care patients affect their sleep quality and perceived stress level, as well as that some components of sleep quality and perceived stress level are related. Palliative care is holistic in nature, encompassing symptom management; therefore, the importance of patients' psychosocial integrity should not be overlooked. Consequently, identifying components that may hinder symptom management and addressing the patient comprehensively will be crucial.

The effect of audiobooks on sleep quality and vital signs in intensive care patients

OBJECTIVE

Improving sleep quality in the intensive care unit is significant for the recovery process. This study investigated the effect of listening to audiobooks on sleep quality and vital signs in intensive care patients.

METHODS

This quasi-experimental study utilized the pre-posttest design, involving control and intervention groups. The study was conducted in the internal medicine intensive care unit of a hospital in Turkey between January-June 2022. Standard nursing care was given to both groups on the first night, and the Sleep Evaluation Form and Richard Campbell Sleep Scale were used to measure sleep quality in the morning. On the second day, the intervention group listened to a recorded story, and the control group had standard care. Sleep quality and vital signs were measured again.

RESULTS

Data from 56 participants were analyzed. Noise (96.4%), light (69.6%), unfamiliar environment (64.8%), concerns about illness (33.9%), and care and treatments (58.9%) are the main causes of sleep disruption. The effect of these factors decreased in the intervention group after the Audiobook Listening Practice, which significantly improved the sleep quality of the ICU patients (p < 0.001). Among the vital signs, a significant difference was found in pulse and blood pressure (p < 0.001), while no changes were observed in temperature and respiratory rate in time group interaction (p > 0.05).

CONCLUSIONS

The Audiobook Listening Practice improved sleep quality and life parameters in the ICU. Nurses can use the practice to improve sleep quality in intensive care units.

IMPLICATIONS FOR CLINICAL PRACTICE

Evidence-based studies are needed to improve the sleep quality of patients in intensive care units, to ensure clinical improvement, and to reduce the length of stay at hospital. The practice is effective in manipulating environmental stressors. This low-cost method significantly improves patient care activities. It is recommended to integrate such complementary activities into intensive care units, to train nurses about the practice, and to support the practice with new studies.

Effects of aromatherapy with Matricaria chamomile essential oil on anxiety and hemodynamic indices in patients with acute coronary syndrome, 2021: a randomized controlled trial

BACKGROUND

Patients with Acute Coronary Syndrome (ACS) experience high levels of anxiety that may cause instability of hemodynamic indices, increased risk of ischemia, myocardial infarction and poor quality of life. Aromatherapy can affect patients' anxiety levels and improve hemodynamic indices. This study aimed to evaluate the efficacy of aromatherapy on anxiety and hemodynamic indices in ACS patients.

METHODS

This study was a double-blind, randomized clinical trial conducted on 154 ACS patients. The participants were classified into two equal groups of intervention and placebo through the block randomization method. The data collection tools consisted of demographic information, a shortened 6-item version of the Spielberger questionnaire and a form of hemodynamic indices. For two consecutive nights, the intervention group inhaled 7 drops of the chamomile essential oil (%10) and the placebo group inhaled 7 drops of the sesame oil poured on a sterile cotton ball. The hemodynamic indices were collected half an hour before, one and four hours after the intervention until the next morning. The Spielberger questionnaire was completed once before the intervention and once after the end of the intervention, by the researcher through an interview. The number of heart rate (HR) was counted for a full minute. Also, the blood pressure (BP) of all the samples was measured by the researcher. Data analysis was done using Chi-square, paired t-test, and analysis of variance (ANOVA) in SPSS22.

RESULTS

The mean and standard deviation of the age of patients were 58/2 ± 11.6 and 59.7% of them were female. The results of ANOVA showed a significantly lower anxiety score as well as systolic blood pressure (SBP), diastolic blood pressure (DBP) and HR in the intervention group compared to those of the placebo group (P < 0.001). The decrease in anxiety score after the intervention, in the intervention and placebo groups was (5.2 ± 1.9) and (1 ± 1. 18) respectively. In the intervention group, the SBP and DBP after the intervention, was significant (P < 0.05). Also, the HR was significant (P < 0.001) after the intervention.

CONCLUSIONS

Aromatherapy could reduce anxiety and improve hemodynamic indices in ACS patients.

TRIAL REGISTRATION

IRCT20080825001083N11.

Different nursing interventions on sleep quality among critically ill patients: A systematic review and network meta-analysis

BACKGROUND

Critically ill patients in intensive care often struggle with disrupted sleep, a prevalent issue in this population. However, the question of which non-pharmacological intervention is most effective in enhancing sleep quality remains unanswered. This study was conducted to comprehensively evaluate and compare the efficacy of various non-pharmacological interventions aimed at improving sleep quality among critically ill individuals.

METHODS

We conducted a search of PubMed, Embase, and the Cochrane Library (Cochrane Central Register of Controlled Trials) without language restrictions to identify articles published until July 15, 2023. Randomized controlled trials (RCTs) that investigated various nursing interventions designed to improve sleep quality in critically ill patients were included in this network meta-analysis. All analyses were performed using R software (version 3.4.3) with the "gemtc" package.

RESULTS

A total of 2036 patients from 31 RCTs were included in the network meta-analysis, involving 11 different nursing interventions (routine care, relaxation combined with imagery (RI), nursel, music + earplugs + eye masks, music, eye masks, earplugs + eye masks, earplugs, aromatherapy, Warm footbath combined with acupoint exercise (WFA), Virtual reality meditation (VR)). Eye masks and earplugs + eye masks were associated with improved sleep quality compared to routine care intervention (P < .05).

CONCLUSIONS

In summary, eye masks and earplugs + eye masks stand out as the most effective interventions for enhancing sleep quality in critically ill patients. Therefore, critical care nurses should consider incorporating the use of eye masks alone or combining music with eye masks into the sleep care regimen for critically ill patients.

The Effect of Reiki and Aromatherapy on Vital Signs, Oxygen Saturation, and Anxiety Level in Patients Undergoing Upper Gastrointestinal Endoscopy: A Randomized Controlled Study

This randomized controlled study aimed to determine the effect of Reiki and aromatherapy on vital signs, oxygen saturation, and anxiety level in patients undergoing upper gastrointestinal endoscopy. The sample consisted of 100 patients divided into Reiki (n = 34), aromatherapy (n = 33), and control (n = 33) groups. Data were collected 3 times (before, during, and after the procedure) using a descriptive characteristics questionnaire, a follow-up form, and the State Anxiety Subscale. The Reiki group had a mean State Anxiety Subscale score of 53.59 ± 2.98 and 43.94 ± 4.31 before and after the procedure, respectively. The aromatherapy group had a mean State Anxiety Subscale score of 54.03 ± 4.03 and 43.85 ± 3.91 before and after the procedure, respectively. The control group had a mean State Anxiety Subscale score of 38.79 ± 4.68 and 53.30 ± 7.26 before and after the procedure, respectively (P < .05). The results showed that the Reiki and aromatherapy groups had significantly lower State Anxiety Subscale scores than the control group after the procedure, indicating that Reiki and aromatherapy help reduce anxiety levels. There was a significant difference in the mean respiratory rates and oxygen saturation levels between the groups (P < .05). In conclusion, patients who do Reiki or undergo aromatherapy are less likely to experience anxiety before upper gastrointestinal endoscopy.

Effectiveness of cold application and lavender oil on pain during drain removal: A randomized clinical trial

Background and Aim

Analgesics are frequently used to prevent acute pain while removing the drain. Additional non-pharmacological methods have come to the agenda as a result of the fact that the pain cannot be fully controlled, and the pharmacological treatment response is variable. Our research was intended to determine the effectiveness of lavender aromatherapy and cold application in controlling pain during drain removal procedure.

Materials and Methods

The sample of the prospective randomized controlled study consisted of 121 patients. Patient data were collected using the introductory information form and the numerical pain scale. Four groups of patients were formed (lavender oil, oxygen, cold application, control), respectively. In all groups, vital signs and pain levels were evaluated before the drain removal procedure, as soon as and 15 minutes after it was withdrawn.

Results

Within the limits of study, lavender aromatherapy and cold application to the drainage area were found to be effective in reducing pain during drainage. When the effect on vital signs was evaluated, it was found that the pre-procedure systolic blood pressure was higher in both the lavender group and the cold application group than the post-procedure systolic blood pressure, and the respiratory rate was higher in the control group during the procedure.

Conclusions

According to the study, it was found that applying lavender and cold application to the patients before the drainage procedure was effective in controlling pain.

Effectiveness of aromatherapy on anxiety and sleep quality among adult patients admitted into intensive care units: A systematic review

PURPOSE

This review aims to evaluate the effectiveness of aromatherapy on anxiety and sleep quality among adult patients admitted to an intensive care unit.

MATERIALS AND METHODS

A systematic search for published and unpublished studies across nine databases and sources were conducted. Randomised Controlled Trials and Controlled Clinical Trials, which assessed the effectiveness of aromatherapy on anxiety and sleep quality among intensive care unit patients, were included in this review. Only studies that used aromatherapy as a single intervention were included. Narrative synthesis was conducted across all outcomes due to high heterogeneity across studies.

RESULTS

A total of 26 studies involving 2176 participants across six countries were included in this review. Most studies had an overall high risk of bias. Publication bias was detected in the studies. Findings have shown that aromatherapy may be effective in reducing anxiety based on the low GRADE certainty of evidence, and improving sleep quality based on the very low GRADE certainty of evidence. Inconsistencies in findings were also observed.

CONCLUSION

Aromatherapy might be beneficial on anxiety and sleep quality among intensive care unit patients, however, the level of evidence is very low, based on the low quality of studies. Considerations can be made to incorporate aromatherapy into existing interventions that improve anxiety and sleep quality in the intensive care unit. Due to inconsistencies in findings, further research can be done to investigate and strengthen these evidence.

IMPLICATION FOR CLINICAL PRACTICE

This review has demonstrated that aromatherapy may have benefits on anxiety and sleep quality. Despite uncertain evidence, aromatherapy may still be considered as a complementary or alternative option to improve anxiety and sleep quality among intensive care patients as it is relatively safe, cost-effective and easy to implement (Buckle, 2014). However, proper training by a professional clinical aromatherapist is needed to ensure there is screening of patients for suitability, proper technique for administering aromatherapy, safe handling of essential oils and monitoring for adverse events (Farrar & Farrar, 2020).

Relaxing effects of music and odors on physiological recovery after cognitive stress and unexpected absence of multisensory benefit

Several studies have described, often separately, the relaxing effects of music or odor on the autonomic nervous system (ANS) activity. Only a few studies compared the presentation of these stimuli and their interaction within a same experimental protocol. Here, we examined whether relaxing music (slow-paced classical pieces) and odor (lavender essential oil) either presented in isolation or in combination would facilitate physiological recovery after cognitive stress. We continuously recorded the electrocardiogram to assess the high-frequency component of heart rate variability (HF-HRV), an index of parasympathetic activity, and electrodermal activity (EDA), an index of sympathetic activity, 10 min before, during and 30 min after a cognitive stress (i.e., completing timely constrained cognitively demanding tasks) in 99 participants allocated to four recovery conditions (control N = 26, music N = 23, odor N = 24, music+odor N = 26). The stressing event triggered both a significant increase in EDA and decrease in HF-HRV (compared to baseline). During the recovery period, the odor elicited a greater decrease in EDA compared to an odorless silent control, whereas no difference in HRV was observed. Conversely, during this period, music elicited a greater increase in HF-HRV compared to control whereas no difference in EDA was observed. Strikingly, in the multimodal music+odor condition, no beneficial effect was observed on ANS indexes 30 min after stress. Overall, our study confirms that both olfactory and musical stimuli have relaxing effects after stress on ANS when presented separately only, which might rely on distinct neural mechanisms and autonomic pathways.

The effect of lavender on stress in individuals: A systematic review and meta-analysis

BACKGROUND

Lavender is considered as one of the medicinal plants to manage stress. Although many preliminary studies evaluated the effect of lavender on individuals' stress level, to the best of our knowledge, we did not find a study that summarizes the results. Therefore, the present study aimed to estimate the Pooled effect of lavender on the stress level of individuals using systematic review and meta-analysis.

METHOD

A systematic literature review based on PRISMA 2020 was performed on the SID, MagIran, Embase, PubMed, Scopus, Web of Science (WoS) databases, and Google Scholar motor engine using related MeSH/Emtree and ‎Free Text words,‎ including "Lavender*", "Lavandula*", "Stress*", "Stress Disorders, Traumatic", and "Stress, Psychological" with no time limitation until August 2021: We also searched two Iranain free local resourses including MagIran https://www.magiran.com and Scientific Information Database (SID) https://www.sid.ir. The quality assessment of studies was performed using JBI checklist. Heterogeneity among studies was quantified using I² index and Random Effects model was used to combine the data and perform the meta-analysis.

RESULTS

In the initial search, 1520 articles were found. After excluding the irrelevant studies, finally, 21 articles with a sample size of 791 in the intervention group and 804 in the control group were included in the meta-analysis. As a result of combining the studies, stress score after using lavender in the intervention group showed a significant decrease of 0.63 ± 0.13 (95% CI) more than that in the control group (P < 0.001). The results of subgroup analysis demonstrated that the highest standardized mean difference (SMD) before and after the intervention in the intervention group compared to the control group was related to L. angustifolia species with 0.73 ± 0.22, student groups with 2.27 ± 1.34, and diagnostic tool of Perceived Stress Scale (PSS) with 0.82 ± 0.42, indicating that the difference between the groups was statistically significant (P < 0.001).

CONCLUSION

The pooled estimation of this systematic reiew and meta-analysis revealed that lavender significantly reduces individuals' stress. Therefore, it seems that the use of lavender can be considered as a part of a stress management programs, especially in student groups.

Nonpharmacological interventions for agitation in the adult intensive care unit: A systematic review

BACKGROUND

Person-centred nonpharmacological strategies should be used whenever possible to reduce agitation in the intensive care unit due to issues related to an overreliance on physical restraints and psychoactive drugs. However, the effect of nonpharmacological interventions to reduce agitation is unclear.

OBJECTIVES

The objectives of this study were to systematically review studies that evaluate the effectiveness of nonpharmacological interventions designed to prevent and minimise or manage patient agitation in the adult intensive care unit.

METHODS

This systematic review was conducted following the Joanna Briggs Institute's Systematic Review of Effectiveness method and a priori PROSPERO protocol. Quantitative studies were identified from seven databases, including MEDLINE, EmCare, CINAHL, Web of Science, PsycINFO, Scopus, and Cochrane Library. In addition, grey literature from several repositories and trial registers was searched. The primary outcome of interest was the effect on prevention, minimisation, and management of agitation. The quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE).

RESULTS

Eleven studies were included (n = 882). Meta-analyses of two studies demonstrated significantly lower levels of agitation (measured with the Richmond Agitation Sedation Scale) in the group receiving a multicomponent nonpharmacological intervention than in those receiving usual care. Individual studies showed a significant effect of nature-based sounds, music, foot reflexology, healing touch, and aromatherapy. The type of the endotracheal suction system did not affect levels of agitation. Overall, the certainty of the findings was rated very low. Harms and adverse effects were not reported in any studies.

CONCLUSIONS

Nonpharmacological interventions have the potential to reduce levels of agitation in the intensive care unit. However, inconsistencies in reporting, low quality of methodological designs, and small sample sizes impact the certainty of the results. Future trials must include larger sample sizes, use rigorous methods to improve knowledge in this field, and consider a range of other outcomes.

Salvia officinalis L. Essential Oil: Characterization, Antioxidant Properties, and the Effects of Aromatherapy in Adult Patients

The purpose of this study is to reveal the chemical and biochemical characteristics and the potential aromatherapy applications of the essential oil (EO) of Salvia officinalis (common sage) within a hospital environment. The chemical composition was determined by gas chromatography with mass spectrometry and ATR-FTIR spectroscopy. Three types of sage EOs were included in this study: two commercial oils and one oil obtained by in-house hydrodistillation. Based on the findings, these EOs were included in different chemotypes. The first two samples were similar to the most common chemotype (α-thujone > camphor > 1,8-cineole > β-thujone), while the in-house sage EO revealed a high content of 1,8-cineole, borneol, α-thujone, similar to the Dalmatian type. The latter sample was selected to be evaluated for its antioxidant and medical effects, as borneol, a bicyclic monoterpene, is known as a substance with anesthetic and analgesic effects in traditional Asian medicine. The study suggests that the antioxidant capacity of the sage EO is modest (33.61% and 84.50% inhibition was determined by DPPH and ABTS assays, respectively), but also that the inhalation of sage EO with high borneol content by hospitalized patients could improve these patients’ satisfaction.

A critical review on clinical evidence of the efficacy of lavender in sleep disorders

Sleep disorders are one of the most prevalent psychiatric diseases. Insomnia is the most common sleep disorder amongst the general population. It is also one of the most frequent complaints in primary healthcare centers. Lavender is called "the broom of the brain" in different oriental traditional medicines. It is one of the most used plants for patients with sleep disorders. This study reviews what is currently known about the use of lavender for sleep disorders in patients with different diseases, from cancers and end-stage renal disease to neurological-psychiatric diseases (e.g., depression, dementia, and autism), respiratory, cardiac, and metabolic diseases. Additionally, its most used administration route is the inhalation of its essential oil (i.e., aromatherapy) alone or in combination by massage. Some limitations of the reviewed literature were discussed briefly. Overall, this critical review provides promising evidence of the lavender efficacy for sleep disorders in a wide variety of populations and diseases. However, further clinical studies with robust design and longer durations of intervention are necessary for more evidence-based judgment on its effect on sleep problems and to investigate its mechanism of action.

Visualizing Research Trends and Identifying Hotspots of Traditional Chinese Medicine (TCM) Nursing Technology for Insomnia: A 18-Years Bibliometric Analysis of Web of Science Core Collection

Objective

To explore the research hotspot and frontier direction of TCM nursing of insomnia and provide reference for the follow-up study of the optimal scheme of TCM nursing of insomnia.

Background

Insomnia is a common sleep-wake disorder, affects 6–10% of adults and was associated with independent higher risks of cardiovascular disease and diabetes. TCM Nursing Techniques of insomnia has a long history and has shown a definite impact. However, it's still lack of analysis in the field of the most commonly used and effective techniques, as well as the co-morbidities associated with insomnia. Therefore, the database was searched and analyzed to find effective TCM Nursing Techniques for insomnia and related diseases related to insomnia.

Method

Randomized controlled trials on the intervention of TCM Nursing Techniques in insomnia were retrieved from Web of Science Core Collection and imported into CiteSpace 5.6.R5 visualization software. The works of literature were co-cited by keywords authors and institutions for visual analysis, and the co-morbidities associated with insomnia of TCM Nursing Techniques in literature was extracted manually. The symptoms of co-morbidities associated with insomnia were imported into Cytoscape 3.9.0 software and clustered by CytoHubba.

Result

As of October 20, 2021, the literature published in the last 20 years from Web of Science Core Collection was screened, and the publication period of the included literature was from 2004 to 2021. From 2016 to now, the total number of articles has been increasing. A total of 146 articles were included, and the highest production year was 2020. There is little cooperation between states, institutions, and authors. China (including Hong Kong and Taiwan) and Hong Kong Polytech University are leading countries and institutions in this area. MYUNGHAENG HUR is the most cited author, and J ALTERN COMPLEM MED is the most cited journal. According to cluster analysis and keyword frequency, auricular therapy, aromatherapy, and acupressure are the three most commonly used techniques. While the top five co-morbidities are fatigue, anxiety, depression, pain and hemodialysis. The three frontier topics and the main research directions are sleep quality, comorbid insomnia and clinical trial design.

Conclusion

We found that acupressure, aromatherapy, and auricular acupoint therapy are the most commonly used nursing methods of TCM to intervene in insomnia. However, these studies have limitations such as small sample size, lack of objectivity in evaluating sleep quality, and high heterogeneity of intervention measures, which are not conducive to forming TCM clinical nursing guidelines. Therefore, it is necessary to adopt objectified sleep quality evaluation methods, select suitable acupoints according to TCM theories, and design multi-center large-sample clinical trials based on the safety principle of randomized blind control. This study provides an in-depth perspective for insomnia research on TCM Nursing Techniques and includes information for follow-up research on TCM Nursing Techniques of insomnia.

Evaluating Advanced Practice Nurses' Burnout and Potential Helping Modalities

Health care providers are experiencing increased stress during the coronavirus disease 2019 pandemic. While it is understood that increased stress leads to burnout, limited research has been conducted to evaluate advance practice nurse response to coronavirus disease 2019, and more specifically, self-identified modalities that may decrease stress in the workplace or at home. This pilot study evaluated advance practice nurse-perceived burnout and evaluated perceived needs and/or perception of modalities aimed at reducing stress and improving well-being, such as essential oils, quiet room, soothing music, art therapy, pet therapy, and mobile applications, that could be easily accessed in the workplace.

Non-pharmacological sleep interventions for adult patients in intensive care Units: A systematic review

OBJECTIVES

To synthesize and evaluate current non-pharmacological sleep interventions for critically ill adult patients in intensive care units and provide recommendations for future studies of non-pharmacological means of improving this population's sleep quality.

RESEARCH METHODOLOGY/DESIGN

The literature search was conducted following PRISMA guidelines. Seven databases CINAHL, PsycINFO, Embase, Medline, Cochrane Library, Web of Science, and Scopus and three keywords, sleep, intervention and intensive care unit were employed. All possible combinations of the keywords and similar words were considered. Included studies were primary studies, involved adult intensive care unit patients, focused on non-pharmacological sleep interventions, measured subjective and/or objective sleep quality and were published in English between January 2010 and September 2020.

RESULTS

The 20 included studies examined different types of non-pharmacological sleep interventions involving use of earplugs, an eye mask, white noise, music, aromatherapy, massage, acupressure, light intensity, a sleep hygiene protocol, quiet time and minimization of nursing care. Of 18 studies employing an experimental design, most reported that non-pharmacological interventions improved sleep quality. All these interventions involved environmental factors or complementary relaxation strategies.

CONCLUSIONS

Non-pharmacological sleep interventions can have a positive influence on sleep quality in critically ill patients, but more research is needed to determine their effectiveness.

Warm Footbaths with Sinapis nigra or Zingiber officinale Enhance Self-Reported Vitality in Healthy Adults More than Footbaths with Warm Water Only: A Randomized, Controlled Trial

Objectives

To examine the effects of warm footbaths with thermogenic medicinal powders on vitality and heart rate variability in healthy adults. Intervention and Outcome. Seventeen healthy young adults (22.1 ± 2.4 years, 11 females) received three footbaths (WA: warm water only; GI: warm water and ginger; MU: warm water and mustard) in randomized order with a crossover design. We assessed vitality with the Basler Befindlichkeit questionnaire (BBS) and heart rate variability (HRV) before (t0), immediately after (t1), and 10 minutes following footbaths (t2). The primary outcome measure was self-reported vitality, measured via the BBS, at t1.

Results

The primary outcome measure, self-reported vitality, was higher after GI and tended to be higher after MU compared to WA with medium effect sizes (GI vs. WA, mean difference −2.47 (95% CI −5.28 to 0.34), p_adj=0.048, d_adj = 0.74), MU vs. WA, −2.35 (−5.32 to 0.61), p_adj=0.30, d_adj = 0.50). At t2, the standard deviation of beat-to-beat intervals (SDNN) of HRV increased, and the stress index tended to decrease after all three footbath conditions with small to medium effect sizes (0.42–0.66).

Conclusion

There is preliminary evidence that footbaths with thermogenic agents GI and MU may increase self-reported vitality during a short-time period with a more pronounced effect with GI. After a short follow-up, all three conditions tended to shift the autonomic balance towards relaxation. Future research should investigate these effects in clinical samples with a larger, more diverse sample size.

Holistic Approaches to Support Sleep in the Intensive Care Unit Patient

Sleep disruption in intensive care unit patients has internal, interpersonal, behavioral, and environmental factors to consider when developing sleep promotion protocols. Holistic approaches are integrative practices that go beyond modifying environmental factors. This article presents 3 holistic approaches that are cost-effective, easy to use, and independent nursing actions that are integrative in nature. Aromatherapy, guided imagery, and mindfulness show promising effects in the literature to improve comfort, anxiety and stress, which are thought to improve sleep.

Smell and Stress Response in the Brain: Review of the Connection between Chemistry and Neuropharmacology

The stress response in the brain is not fully understood, although stress is one of the risk factors for developing mental disorders. On the other hand, the stimulation of the olfactory system can influence stress levels, and a certain smell has been empirically known to have a stress-suppressing effect, indeed. In this review, we first outline what stress is and previous studies on stress-responsive biomarkers (stress markers) in the brain. Subsequently, we confirm the olfactory system and review previous studies on the relationship between smell and stress response by species, such as humans, rats, and mice. Numerous studies demonstrated the stress-suppressing effects of aroma. There are also investigations showing the effects of odor that induce stress in experimental animals. In addition, we introduce recent studies on the effects of aroma of coffee beans and essential oils, such as lavender, cypress, α-pinene, and thyme linalool on the behavior and the expression of stress marker candidates in the brain. The transfer of volatile components into the brain is also discussed while using the results of thyme linalool as an example. These studies may provide a good opportunity to connect chemical research at the molecular level with neuropharmacological approaches in the future.

Evaluation of the Effects of an Intervention Intended to Optimize the Sleep Environment Among the Elderly: An Exploratory Study

Purpose

The objective of this exploratory study was to evaluate the effects of a brief intervention intended to optimize the sleep environment in older people living in the community and to examine the way these effects change over time.

Methods

The sample was made up of 44 participants (19 men and 25 women) aged 65-85 years, with a mean age of 71.4. The intervention consisted in a group training session that covered the reasons for and ways to ("why" and "how") optimize a sleep environment. It comprises six themes: air quality and odors, luminosity, noises and sounds, comfort of the mattress, comfort of the pillow, and temperature. Participants completed a set of questionnaires before the intervention, and one month and four months later.

Results

Four months after the intervention, the replies to the questionnaires showed that the participants experienced reduced severity of insomnia, sleep latency and anxiety. The subjective quality of the participants' sleep along with their sleep efficacy also increased significantly during the same period.

Conclusion

A brief intervention intended to optimize the sleep environment appears promising as an addition or alternative to the two other sleep improvement options generally offered to older people: medication and cognitive behavioral therapy.

Reliability of the Korean version of the Richards-Campbell Sleep Questionnaire

BACKGROUND

Sleep disorders are common in critically ill patients. Unfortunately, sleep assessment is challenging in many intensive care units (ICUs). The Richards-Campbell Sleep Questionnaire (RCSQ) is a simple subjective tool that has been validated and used in many countries. This study aimed to evaluate the reliability of the Korean version of the RCSQ (K-RCSQ).

METHODS

This prospective, cross-sectional, observational study was conducted in the ICUs of two hospitals. In total, 52 consenting patients answered questionnaires regarding their previous night's sleep (K-RCSQ) and the noise they experienced (range, 0-100).

RESULTS

The K-RCSQ showed excellent internal consistency of 0.960 by Cronbach's alpha. The mean total score of the K-RCSQ was 41.9±28.9 (range, 0-100). The mean perceived ICU noise score was 40.7±28.1 (range, 0-90). There was a significant linear correlation between noise score and average K-RCSQ score (r=-0.37, P<0.001).

CONCLUSIONS

The K-RCSQ demonstrated excellent reliability (internal consistency). This simple tool may help assess sleep quality in critically ill patients and improve the quality of ICU care.

Comparing the effect of aromatherapy with peppermint and lavender on the sleep quality of cardiac patients: a randomized controlled trial

Background

Sleep disorder is a critical problem in cardiac patients. This study aimed to compare the effects of aromatherapy ‌with peppermint and lavender essential oils on the sleep quality of cardiac patients.

Methods

A total of 105 patients were randomly allocated to three groups of peppermint essential oil, lavender essential oil, and control. In each experimental group, the patients inhaled three drops of lavender and peppermint essential oils, whereas the control group received aromatic distilled water. Data were collected using the Pittsburgh Sleep Quality Index (PSQI). The participants completed PSQI before and after the intervention.

Results

There was a significant difference in the mean score of PSQI in each of the experimental groups before and after the intervention; however, the difference was not statistically significant between the experimental groups.

Conclusion

Aromatherapy with lavender and peppermint essential oils can improve the sleep quality of cardiac patients. Therefore, use of this non-pharmacological intervention, as an effective and simple approach, is recommended for cardiac patients.

Trial registration

IRCT, IRCT201601244736N10. Registered 4 November 2016.

The Effect of Lavender Oil on Sleep Quality and Vital Signs in Palliative Care: A Randomized Clinical Trial

BACKGROUND

This study was conducted to determine the effect of lavender oil on sleep quality and vital signs in palliative care patients.

METHODS

We examined 68 patients in a palliative care unit. Vital signs of all the patients were assessed, and also their sleep quality was evaluated using the Richards-Campbell Sleep Questionnaire. Lavender was applied to patients in the experimental group. During the intervention, vital signs of the patients were monitored at 4-h intervals throughout the night, and sleep quality was evaluated during the morning. The same evaluation processes were performed for the control group.

RESULTS

It was observed in the evaluation that lavender application did not affect the vital signs of the patients but it ensured a deeper sleep on the 2nd day after the intervention, facilitated their falling asleep and sleeping again when they were awakened and enhanced sleep quality (p < 0.05). Also, this application decreased the awakening frequency on the 1st and 2nd days and enhanced overall sleep quality (p < 0.05) after the intervention.

CONCLUSIONS

Lavender has no effect on the vital signs of palliative care patients but is an effective and reliable approach to enhance their sleep quality.

Efficacy and safety of lavender essential oil (Silexan) capsules among patients suffering from anxiety disorders: A network meta-analysis

A systematic review and network-meta analysis (NMA) were performed to estimate significance of the anxiolytic effect of lavender essential oil taken as silexan capsules versus other comparators (i.e., placebo/paroxetine/lorazepam). The outcome of interest was Hamilton Anxiety Scale (HAMA). Weighted mean differences (WMD) were calculated to estimate the treatment effect at the confidence interval of 95%. League tables were generated using treatment effect, for all pairwise comparisons, where WMD < 0 favors the column-defining treatment. Five studies were identified with a total of 524 participants receiving treatment with silexan 80 mg and 121 participants taking silexan 160 mg. The NMA results indicated that consumption of silexan 160 mg resulted in higher decline of HAMA score [WMD −1.14 (−1.10, 3.39)] in comparison to silexan 80 mg, placebo [−2.20 (−4.64, 0.24)] and paroxetine [−1.24 (−5.34, 2.85)]. The effect of silexan 80 mg was observed to be same as that of paroxetine. Overall, silexan 160 mg was noticed to be a more efficient treatment giving significant decline in HAMA score across other comparators. However, no improvements in HAMA score was observed for the group receiving lorazepam 0.5 mg when compared to silexan 160 mg, silexan 80 mg, paroxetine 20 mg, and placebo.

Effect of aromatherapy on cancer complications: A systematic review

PURPOSE

The aim of this study was to determine the effect of aromatherapy on cancer complications.

METHODS

In this systematic review, international (PubMed, Web of Science, Scopus, EMBASE and CENTRAL) and national databases (SID and Magiran) were searched from inception of the databases to April 31, 2019. JBI and Jadad scales were used to assess the quality of the studies included.

RESULTS

of 43 Studies conducted on 3239 cancer patients in 13 countries from 1995 to 2019, entered the final stage. The results showed that the aromatherapy improves the various physical and psychological complications, although few studies have shown that aromatherapy had no effect on skin reactions.

CONCLUSION

Considering the various complications and costs in cancer patients, it seems that the aromatherapy can be used as a proper supplemental treatment to improve complications, although further studies are needed to determine the protocol and the standard dosage.

Evaluation of aromatherapy with lavender oil on academic stress: A randomized placebo controlled clinical trial

INTRODUCTION

Academic stress is prevalent among pharmacy students. Several factors such as hectic schedules, courses and exam load as well as lack of recreational time during semester have been reported as determinants of academic stress. Studies revealed; the use of aroma oils especially with relaxant properties may help ease stress.

METHODS

This study aimed to investigate the effect of lavender oil on academic stress during exams in pharmacy students. A randomized-single-blind placebo-controlled trial providing aromatherapy with lavender oil as an intervention was conducted in male pharmacy students. The outcomes assessed included stress, stool pattern, headache and vital signs that comprised of systolic, diastolic blood pressure (SBP and DBP) and heart rate (HR). The study was approved from concerned authority and registered in ClinicalTrials.gov (NCT#03460626).

RESULTS

The placebo and experimental group showed a significant (p < 0.01) difference in stress score (F = 244.865, p < 0.0001), headache VAS score (F = 8.187, p < 0.0001), SBP (F = 11.141, p < 0.0001), DBP (F = 3.873, p < 0.001) and HR (F = 8.537, p < 0.0001); at during-exam time-point as compared to control group. No significance was achieved; among three treatment groups in stool pattern (F = 2.143, p > 0.05) and, at post-exam time-point (p > 0.05).

CONCLUSION

Aromatherapy with lavender oil did not have any effect on academic stress.

TRIAL REGISTRATION

The study was registered prospectively on ClinicalTrials.gov (NCT#03460626) on 19th February 2018.

Advancing Well-Being and Health of Elderly with Integrative Nursing Principles

There is a need for holistic care for the survival of the elderly, to increase their independence in their daily life activities, to improve their health and their well-being in order to ensure a healthy aging. Integrative nursing principles are a field of application of holistic philosophy and may be a guide to health professionals in improving the health of individuals, families and communities. These principles were first announced in 2014, and have been described as a health approach that takes the individual, family and society as a whole together with their environment and relationships and adopts the principle of using all the healing methods in health care. Integrative nursing principles can be used as a guide to holistic assessment and improvement of the health of the elderly. Interventions who take care of them with the environment they live in (home visits), support their existing healing process (focusing to patient during nursing care), benefit from the healing effect of the nature (spending time in nature), strengthen the relationship (mobilization of the social environment) and use all evidence-based healing methods (yoga, tai chi) should be included in the care of elderly individuals. Health professionals should learn integrative nursing principles and care for these principles in order to improve the health and well-being of the elderly. Giving care according to integrative nursing principles can increase the quality of life of the elderly and reduce health spending.