Abstract
This Design for Change proposal attempts to demonstrate how aromatherapy massage can be introduced within the realms of complementary and alternative medicine (CAM) to provide pregnant and childbearing women with a more naturalistic and individualized care option. The proposal uses the Rosswurm and Larrabee’s change model to discuss the various steps of the change process, before demonstrating how the intended project will be implemented, evaluated, integrated, and maintained.
Patients experiencing discomfort are increasingly using complementary interventions, with hand massage and aromatherapy reported as some of the most used interventions in the developed world (Wilkinson, Barnes, & Story, 2008). Aromatherapy, in particular, has gained currency in treating a multiplicity of diseases, conditions and symptoms, as the natural oils used in this therapy (e.g., true lavender, rose, mandarin, sweet orange, sandalwood, geranium) have demonstrated various types of pharmacologic actions (Imanishi et al., 2009).
It has been noted that women in the maternity arena experience a lot of pain and discomfort during childbearing, and that some of the conventional interventions provided in these settings lead to serious side-effects (Dhany, Mitchell, & Foy, 2012; Smith, 2012). Drawing from this elaboration, the present Design for Change proposal attempts to demonstrate how aromatherapy can be introduced within the realms of complementary and alternative medicine (CAM) to provide pregnant and childbearing women with a more naturalistic and individualized care option.
Contribution to the Future of Healthcare
This project will provide pregnant women with a secure and healthy approach to deal with the discomfort experienced during the last months of pregnancy and birth. Although aromatherapy is often viewed as more intrusive than other conventional approaches used to enhance comfort and reduce pain, it is evident that this particular intervention will contribute immensely in reducing complications associated with childbearing (e.g., inability to mobilize during labor due to epidurals and anesthesia) and in maximizing maternal and neonatal outcomes (Dhany et al., 2012). The stakeholders involved in this project include hospital administrators, chief maternity and antenatal nursing officers, antenatal nurses, as well as labor and delivery nurses.
Change Model Overview
The Rosswurm and Larrabee’s change model has been particularly successful in guiding “nurses and other healthcare professionals through a systematic process for the change to evidence-based practice” (Rosswurm & Larrabee, 1999, p. 317). Nursing professionals should use this model as a guide to facilitate change not only due to its capacity to assist in synthesizing empirical and contextual evidence and integrating evidence-based changes into practice (Rosswurm & Larrabee, 1999), but also because of its intuitive, logical, and easily understandable nature, particularly when applied in acute-care and primary-care practice settings (Rempher, 2006).
Step 1: Assess Need for Change
The introduction of aromatherapy massage to compliment other conventional care plans is stimulated by an awareness of patients’ dissatisfaction with some of the conventional care interventions used in pain management due to associated side-effects (Dhany et al., 2012). The current practice for comforting pregnant and childbearing mothers entails the provision of “analgesia such as transcutaneous electrical nerve stimulation (TENS) entonox, pethidine or diamorphine, and epidural anesthesia” (Dhany et al., 2012, p. 933). Evidence-based practices across the world show that, when used with knowledge and caution, plant-based essential oils can provide pregnant and childbearing women with a natural, therapeutic component that enhances their comfort zones through lifting the spirits and supporting a healing environment for the body (Smith, 2012).
Step 2: Link the Problem, Interventions, and Outcomes
The problem concerns the pain and discomfort that pregnant mothers undergo due to their situation. As already mentioned, nursing professionals employ conventional care interventions to deal with pain and discomfort, though most of these interventions have been known to cause adverse side-effects (Dhany et al., 2012). It is thought that the introduction of aromatherapy will addresses the adverse outcomes associated with conventional nursing care during pregnancy, while at the same time providing “a more holistic approach that not only cares for the body but also tends to the mind, spirit, and the environment the person is in” (Dhany et al., 2012, p. 932)
Step 3: Synthesize the Best Evidence
According to Smith (2012), aromatherapy entails “the use of plant-based essential oils for their many health-inducing properties including relaxation, anti-inflammatory, microbial, spasmodic, and pain relief” (Smith, 2012, p. 26). The need to introduce this intervention in managing the pain and discomfort experienced by pregnant mothers is supported in the literature. For example, Smith (2012) explains that aromatherapy and other CAM interventions have a positive impact in alleviating the aches, pains and depressive episodes that accompany the childbearing year, while Dhany et al (2012) conclude in their study that aromatherapy minimizes the use of anesthesia during labor, which in turn improves maternal and neonatal outcomes.
Available literature also demonstrates that aromatherapy massage has been found to work in the management of pain and discomfort involving cancer patients (Imanishi et al., 2009; Wilcock et al., 2004; Wilkinson et al., 2008), stroke patients (Shin & Lee, 2007), infants undergoing major craniofacial surgery (De Jong et al., 2012), and older patients in palliative care (Berger, Taveres, & Berger, 2013).
Step 4: Design Practice Change
The proposed change entails introducing aromatherapy massage in maternity settings for use by pregnant and childbearing mothers to alleviate pain and discomfort. The resources needed include natural oils, training of antenatal and labor/delivery nurses, and avenues for information dissemination. The hospital administration will provide finances needed to purchase the natural oils, while chief maternity and antenatal nurse leaders will introduce a program to train nurses on the use of this therapy.
The nurse leaders, in conjunction with nurses in the department, will also engage in an awareness campaign targeting pregnant mothers to disseminate knowledge about the benefits of this intervention. It is expected that many women will use the intervention not only to relieve the pain and discomfort associated with pregnancy and childbearing, but also to avoid the negative side-effects linked to conventional care options.
Step 5: Implement and Evaluate the Change in Practice
A pilot study will be undertaken within the maternity setting to establish the uptake and viability of this project. The pilot study will take six months to gain a deeper understanding of the project and possible improvement areas. Pain reduction/enhancement levels during the pilot study will be measured using the Iowa Pain Thermometer Scale (Painknowledge.org, 2007), while comfort reduction/enhancement levels will be measured using the COMFORT-behavior scale (De Jong et al., 2012). The scores achieved in these measures will determine the adoption or rejection of the project.
Step 6: Integrate and Maintain the Change in Practice
The recommended change will be communicated to the mentioned stakeholders and efforts will be made to conduct staff in-service education on aromatherapy to create the impetus needed for staff members to start providing the intervention to patients. The relevant stakeholders (e.g., hospital administrators and chief maternity nursing leader) will then be requested to integrate the project into the standards of practice. Pain reduction and comfort enhancement benchmarks will be made to monitor how the intervention is assisting patients to enhance their comfort levels.
References
Berger, L., Taveres, M., & Berger, B. (2013). A Canadian experience of integrating complementary therapy in a hospital palliative care unit. Journal of Palliative Medicine, 16(10), 1294-1298. Web.
De Jong, M., Lucas, C., Bredero, H., Van Adrichem, L., Tibboel, D., & Van Dijk, M. (2012). Does postoperative ‘M’ technique massage with or without mandarin oil reduce infants’ distress after major craniofacial surgery? Journal of Advanced Nursing, 68(8), 1748-1757. Web.
Dhany, A.L., Mitchell, T., & Foy, C. (2012). Aromatherapy and massage intrapartum service impact on use of Analgesia and anesthesia in women in labor: A retrospective case note analysis. Journal of Alternative and Complementary Medicine, 18(10), 932-938. Web.
Imanishi, J., Kuriyama, H., Shigemori, I., Watenabe, S., Aihara, Y., Kita, M…Fukui, K. (2009). Anxiolytic effect of aromatherapy massage in patients with breast cancer. Evidence-based Complimentary & Alternative Medicine, 6(1), 123-128. Web.
Painknowledge.org. (2007). Iowa pain thermometer scale. Web.
Rosswurm, M.A., & Larrabee, J.H. (1999). A model for change to evidenced-based practice. Image: Journal of Nursing Scholarship, 31(4), 317-322. Web.
Rempher, K.J. (2006). Putting theory into practice: Six steps to success. American Nurse Today, 1(2), 41-42. Web.
Shin, B.C., & Lee, M.S. (2007). Effects of Aromatherapy acupressure on Hemiplegic shoulder pain and motor power in stroke patients: A pilot study. Journal of Alternative and Complimentary Medicine, 13(2), 247-251. Web.
Smith, V.C.S. (2012). Aromatherapy as a comfort measure during child bearing year. International Journal of Childbirth Education, 27(3), 26-30. Web.
Wilcock, A., Manderson, C.A., Weller, R., Walker, G., Carr, D., Carey, A.M. (2004). Does aromatherapy massage benefit patients with cancer attending a specialist palliative care day center? Palliative Medicine, 18(4), 287-290. Web.
Wilkinson, S., Barnes, K., & Storey, L. (2008). Massage for symptom relief in patients with cancer: A systematic review. Journal of Advanced Nursing, 63(5), 430-439. Web.