If the sweet fragrance of honeysuckle transports you back to your childhood neighborhood or a particular restaurant aroma conjures up the sights and sounds of your elementary school cafeteria, then you understand the power of scent.
Aromatherapy, a form of herbal medicine that uses specific traditional plant extracts called essential oils, uses that power of scent to help support health and well-being in both general and specialized health care. Hospice providers are integrating it into patient care to help with symptom management and to add to patients’ well-being and quality of life.
“With aromatherapy – we can greatly support quality of life – think of reducing pain and inflammation, diminishing nausea or constipation, relaxing muscles and ligaments and thus improving mobility, supporting immune function, breathing or circulation or offering excellent mouth care as well as skin care,” says former nurse Madeleine Kerkhof, an expert and world-renowned educator in clinical aromatherapy, aqua care and other complementary therapies.
“These actions, in my experience, can often be beneficial for those in hospice care. Aromatherapy and other therapies do not stand in the way of pharmaceuticals or medicine but complement them when performed by a well-trained caregiver,” says Kerkhof, the founder, chair and principal teacher of the Knowledge Institute for Integrative & Complementary (Nursing) Care in The Netherlands.
“I prefer the word ‘AromaCare’ to express what aromatics do for the very ill and dying — it helps care for them in a true holistic manner, rather than aim at a cure or being a type of therapy,” she says. “My goal is to complement standard care rather than being an alternative to it; having it integrated into the many possibilities we have to improve quality of life in hospice.”
Aroma blends can be formulated for a variety of issues. For nausea, Kerkhof may combine a CO2 ginger extract — a CO2 extract is purer and superior to distilled essential oils — with essential oils of lemon, mandarin and peppermint. If a patient is having trouble sleeping, she may try essential oils of lavender, mandarin and vetiver. For muscle spasms and pains, the blend may be copaiba, black pepper, sweet marjoram, ginger and geranium.
“Fragrant essential oils can be significant in supporting emotional, social and spiritual well-being of patients,” Kerkhof says. “Scent can have a great impact on our sense of feeling safe and secure by provoking responses through the limbic system. Creating a pleasant atmosphere and removing offensive odors is so very important.”
“Well-chosen fragrances can offer rest for the nervous and stressed or comfort for the despondent,” she says. “Some essential oils and CO2 extracts can have a profound influence on our mood, the way we experience ourselves and the world. For the very ill, fragrant oils can bring consolation, acceptance, support of trusted rituals and a sense of peace.”
Safety is of key importance, Kerkhof notes. Making a thorough assessment ensures essential oil is safe to use for very frail patients.
“Of course, you need a well-trained caregiver, preferably a professional nurse trained in aromatherapy, or an aromatherapist trained in hospice care, for a successful and safe treatment,” she says. The National Hospice and Palliative Care Organization offers classes on aromatherapy in palliative care as part of continuing medical education for medical professionals.
Essential oils should be administered based on the reason they’re being used, properties of the oil, desired effect and, of course, the patient’s preference. Aromatherapy can be administered several ways, according to the American Journal of Nursing:
- Indirectly breathing the scent that’s been dispersed in the air by a diffuser
- Directly breathing the aroma from a lightly scented cotton ball, tissue or inhaler wick
- Topical application of spray, lotions and gels through light touch and massage
- Through mouthwashes and gargles
“It is imperative to know what kinds of fragrances the patient may dislike and why, especially when we address emotional and spiritual needs,” Kerkhof says.
“Fragrances provoke memories and people respond to them with emotional and instinctive responses. By avoiding those that could bring back bad memories and choosing those fragrances that bring back memories of happier moments and the joys associated with those, we can add a bit of spark and sunshine and help patients and their loved ones cope better.”
Kerkhof has seen aromatherapy work for a hospice patient whose painful years-long mouth inflammation subsided after using Kerkhof’s specialized essential oil mouth gel, and for a bowel cancer patient whose terrible nausea finally subsided with the help of an essential oil inhaler.
“One of my most profound memories is that of a gentleman in hospice care, suffering from extreme pain due to multiple bone tumors. They never found the primary tumor actually, but it had spread to every bone in his body,” she says. “He and his wife loved to spend their holidays in their cabin in the woods, 200 miles south of their home. He so wanted to go there one last time, but his pain was so severe he couldn’t be moved.
“When I heard of him, I made up a blend with essential oils and rich fragrant extracts that reminded him of forest walks in the autumn. I wrote a guided imagery exercise that ‘took’ him and his wife ‘on a trip’ to their cabin deep in the woods on a sunny autumn day. We diffused the oil — just a drop or so — in the room and a CD with gentle forest sounds played in the background. When reading the fantasy to him, he relaxed and smiled, his eyes closed.”
“Afterward, his nurse told me that in those precious moments the patient felt entirely pain-free, even though that would have been impossible. When he passed, it helped his family, who had wonderful memories of him being in peace in his last days.”