Patients in critical conditions often experience anxiety, which exacerbates pain and causes insomnia. The problem attracts attention, as it is validated by the staff’s practical observations, particularly in safety, risk management, and quality assessment issues. The anxiety problem is relevant, as it significantly impacts both patients and the organization providing care. Patients suffer because anxiety interferes with healing and can prolong their hospital stay. Consequently, patients’ satisfaction and safety levels are falling, hindering the organization and leading to additional expenses. The current practice focuses on medicines to reduce anxiety and its effect. However, pharmacological agents can interfere with treatment and have side effects. Therefore, studying and evaluating the effectiveness of alternative anxiety reduction methods can help solve the problem. Particularly, there is a need to investigate aromatherapy and its effect on patients experiencing anxiety.
PICO Components and EBP Question
PICO Components:
- P (Patients) – patients at risk for anxiety. The target group for intervention to solve the described problem is patients at high risk of anxiety. They often include people with critical conditions or trauma survivors, preoperative patients, and those prone to anxiety in character.
- I (Intervention) – aromatherapy. The proposed intervention as a method involves the use of essential oils in various ways as inhalation, massage, or bath for relaxation.
- C (Comparison) – no application of aromatherapy. The comparison applies to patients’ conditions before the intervention implementation.
- O (Outcome) – anxiety level reduction. Aromatherapy is expected to reduce anxiety and, as a consequence, improve treatment effects.
Question: Among the patients at risk for anxiety, does the aromatherapy reduce anxiety level compared to no aromatherapy application?
Research-Based Article
Background and Purpose
A research-based article was studied and evaluated to answer the proposed EBP question. “Effect of aromatherapy on preoperative anxiety in adult patients: A meta-analysis of randomized controlled trials” was written by a group of Chinese scientists (Huang et al., 2021). The authors note that anxiety among preoperative patients is common and leads to complications, but it is preventable. The research background also suggests that the aromatherapy method reduces anxiety and the manifestation of somatic symptoms. As a result, Huang et al.’s (2021) purpose is to evaluate aromatherapy’s effect on anxiety in preoperative patients. The authors conducted a meta-analysis of randomized controlled trials to achieve their goal.
Method, Evidence Level, and Ethical Considerations
Meta-analyses included the selection and review of topic-relevant trials and their subsequent analysis. According to the Research Evidence Appraisal Tool, the considered article corresponds to level I of evidence. The researchers used seven databases to find the sources and then checked publications with the help of the Cochrane Risk Assessment Tool and Grades of Recommendation, Assessment, Development, and Evaluation (GRADE). Ten randomized controlled trials were eventually included in the quantitative synthesis.
The authors used a random-effects model and inverse variance method to analyze extracted data. The meta-analysis did not work with humans or animals, and their work does not include ethical considerations. The article has several drawbacks, identifying a quality rating as B. Good quality. Publication does not meet high quality because its conclusions are not precise due to the method’s restrictions. Moreover, although the authors mention limitations, they do not address them.
Conclusion and Value for EBP
Despite the study’s shortcomings, the authors conclude that aromatherapy can reduce anxiety intensity for preoperative patients. The result is consistent with previous research indicating the effectiveness of the method. Such conclusions suggest that the answer to the posed EBP about aromatherapy benefits is positive. Although the influence of the technique has been compared with placebo and non-targeted anxiety rather than other methods of its management, aromatherapy has the advantage of no side effects. Considering the limitations of the article’s method and the focus on preoperative patients, it is worth expanding the study to confirm the effectiveness of aromatherapy for all patients with anxiety.
Non-Research Article
Background and Purpose
A non-research paper was also analyzed to find evidence for the problem under consideration. Meghani et al.’s (2017) article is devoted to “The effects of aromatherapy and guided imagery for the symptom management of anxiety, pain, and insomnia in critically ill patients” (p. 334). Article’s background notes that complementary and alternative therapies are popular, and even in hospitals, patients prefer to continue using them. The authors also suggest that anxiety, insomnia, and pain are common among patients in intensive care. They set a goal of whether aromatherapy and guided imagery help manage these conditions.
Evidence Level
This article is an integrative review, and it represents level V of evidence. Meghani et al. (2017) investigated three databases and searched for articles exploring two methods – aromatherapy and guided imagery. They selected six studies, including randomized controlled trials, quasi-experimental, and retrospective effectiveness studies, that aimed to investigate the aromatherapy method and its effects on patients. The authors examined the studies’ goals, methods, and findings and synthesized the information in their paper. The quality rating of the article corresponds to B. Good quality, since their results suggest the need for further research to validate the method’s effectiveness. The review does not have ethical consideration as it involves examining published material rather than working with humans or animals.
Conclusion and Value for EBP
The authors of the considered paper conclude that aromatherapy can benefit patients in critical conditions in managing their anxiety. 5 out of 6 publications studied indicate in favor of such a conclusion. Meghani et al. (2017) also note that aromatherapy may subsequently affect such essential aspects as service quality, length of stay, and use of anxiety medication. By evaluating aromatherapy intervention and its influence, the article helps answer the proposed EBP question and suggest assumptions’ validity.
Practice Change
The recommended practice change is aromatherapy application to reduce anxiety levels among patients. Huang et al.’s (2021) note that such a method is helpful and has no harmful effect compared with medicines. Meghani et al. (2017) also confirm the aromatherapy benefit and its potential to increase patient satisfaction and treatment effectiveness. The key stakeholders who need to support practice change are nurses, supply managers, and nurse educators. Nurses promote the method and make aromatherapy use possible, managers provide the necessary means, and educators inform about the possibilities. Their involvement is possible through reach – by phone, e-mail, and other ways to get an opinion. Another engagement strategy is creating focus groups to discuss and implement interventions.
Barriers and Outcomes
During the practice change recommendation implementation, there may be a barrier of nurses’ unwillingness to use aromatherapy. A strategy to overcome the obstacle may include proving the method’s effectiveness for patient outcomes and financial incentives for improving patient scores. Measurement of intervention outcome can be done through patient reports of anxiety levels before and after aromatherapy. Anxiety level reduction will indicate the success of the method.
Conclusion
Anxiety among patients poses a significant challenge to health care organizations. It worsens the condition of patients and thereby reduces the effectiveness of their treatment. Methods alternative to pharmacological intervention may be effective and have no side effects. Examination of the literature suggests that such an alternative method as aromatherapy can effectively reduce anxiety. However, the research highlights the difficulty of studying the issue and the further need for more comprehensive approaches to explore the efficacy of aromatherapy.
References
Huang, H., Wang, Q., Guan, X., Zhang, X., Kang, J., Zhang, Y., Zhang, Y., Zhang, Q., & Li, X. (2021). Effect of aromatherapy on preoperative anxiety in adult patients: A meta-analysis of randomized controlled trials. Complementary Therapies in Clinical Practice, 42, 101411. Web.
Meghani, N., Tracy, M. F., Hadidi, N. N., & Lindquist, R. (2017). Part II: The effects of aromatherapy and guided imagery for the symptom management of anxiety, pain, and insomnia in critically ill patients: An integrative review of current literature. Dimensions of Critical Care Nursing, 36(6), 334-348. Web.