CURRENTSTATE / GAP / FUTURESTATE
Emergency Department Staff currently undergo high levels of stress and decreased energy levels due to high patient acuity, overcrowding, boarding inpatients and Post Traumatic Stress. / A healthier environment with increased energy and decreased stress. With continued promotion of wellness and positive energy in a holistic way that enriches those staff members in our department.
Due to multiple patient conditions the department frequently experiences foul odors. / Minimized and decreased foul odors within the department through diffusion of therapeutic essential oils.
STRENGTHS / WEAKNESSES
  • High level of staff interest to enhance the environment and promote wellness
  • Increase Energy
  • Decrease Stress
  • Eliminate Foul Odors
  • Promotes Further Education
  • Supports Vanderbilt’s Mission Statement
  • Shows our ongoing commitment and dedication to our staff
  • Increases Staff Wellness
  • Supported by Evidenced Based Practice
  • Improves air quality by decreasing airborne pathogens
  • Advantage of using Certified Pure Therapeutic Grade Essential Oils
  • No synthetic/perfume additives
  • Unlikely risk of adverse effects
/
  • Lack of Education and Understanding
  • Change of Mindset

OPPORTUNITIES / THREATS
  • Pilot Wellness initiative study with measurable outcomes.
  • Furthering Education
  • Development of a Wellness Model that can be used by other departments
  • Fortifying relationships
  • Developing Leadership for staff promotion
  • Staff Retention
  • Creates a more appealing place to work
/
  • Closed Mindedness
  • Resistance to Change
  • Lack of Education and Understanding

Evidence Based Practice

Many hospitals are now incorporating the use of Essential Oils. For example,HarrisMethodistFort WorthHospital uses 33 different Therapeutic Grade Essential Oils that are dispensed by their pharmacy. Studies show they relieve stress and anxiety for patients and staff, findings also show they can reduce pain and facilitate sleep for the patient.

HOSPITALS AND OTHER INSTITUTIONS EMPLOYING ESSENTIAL OILS: A SAMPLING

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DesertSamaritanMedicalCenter – Mesa, Arizona

Fountain ValleyHospital – Fountain Valley, California

OrangeCoastMemorialHospital – Fountain Valley, California

SaddlebackMedicalCenter – Laguna Hills, California

MidwayHospital – Los Angeles, California

Children’s Hospital and HealthCenter – San Diego, California

San Diego Hospice – San Diego, California

CaliforniaPacificMedicalCenter – San Francisco, California

O’Connor Hospital – San Jose, California

AspenValleyHospital – Aspen, Colorado

MemorialHospital – Colorado Springs, Colorado

St.AnthonyHospitals, Centura Health – Englewood, Colorado

GunnisonValleyHospital – Gunnison, Colorado

GriffinHospital – Derby, Connecticut

St. Francis Medical Center – Hartford, Connecticut

WindhamCommunityMemorialHospital – Willimantic, Connecticut

HolyCrossHospital – Sunrise, Florida

NorthsideHospital – Atlanta, Georgia

NorthHawaiiCommunityHospital – Kameula, Hawaii

AdvocateGoodShepherdHospital – Barrington, Illinois

St. James Health and Wellness Institute – Chicago, Illinois

Advocate Healthcare – Oakbrook, Illinois

DeaconessHospital – Evansville, Indiana

RiverviewHospital – Noblesville, Indiana

Memorial Health System – South Bend, Indiana

Charlton Health System – Fall River, Massachusetts

St. Luke’s Health Care System – New Bedford, Massachusetts

MortonHospital and MedicalCenter – Taunton, Massachusetts

Tobey Health Systems – Wareham, Massachusetts

Barbara Ann Karmanos Cancer Institute – Detroit, Michigan

BronsonMethodistHospital – Kalamazoo, Michigan

Mercy Hospital Group – Port Huron, Michigan

St. John’s Health – Warren, Michigan

Children’s Hospital – St. Paul, Minnesota

RegionsHospital – St. Paul, Minnesota

St. Peter Community Hospital – St. Paul, Minnesota

Woodwinds Health Campus – Woodbury, Minnesota

Barnes-JewishHospital – St. Louis, Missouri

St. Luke’s Hospital – Chesterfield, Missouri

BergenMercyMedicalCenter – Omaha, Nebraska

St. Rose Dominican Hospital – Henderson, Nevada

Wentworth-DouglasHospital – Dover, New Hampshire

Cooper Hospital/University Medical Center-Camden, New Jersey

St. Barnabas Health Care System – Hackensack, New Jersey

MountainsideMedicalCenter – Montclair, New Jersey

Bellevue Women’s Hospital – Albany, New York

St. Peter’s MedicalCenter – Albany, New York

Northern Westchester Hospital Center-Mount Kisco, New York

ColumbiaPresbyterianMedicalCenter – New York, New York

Morgan Stanley Children’s Hospital – New York, New York

New York-Weill Cornell Children’s Hospital-New York, New York

HughChathamMemorialHospital – Elkin, North Carolina

IredellMemorialHospital – Statesville, North Carolina

Children’s HospitalMedicalCenter – Akron, Ohio

HighlineCommunityHospital – Burien, Washington

ElmbrookMemorialHospital – Brookfield, Wisconsin

AllianceCommunityHospital – Alliance, Ohio

Cleveland Clinic Health System – Chagrin Falls, Ohio

UHHSBainbridgeHealthCenter – Chagrin Falls, Ohio

University Hospitals’ Health System – Cleveland, Ohio

MercyHealthCenter – Oklahoma City, Oklahoma

Harris Methodist Fort Worth Hospital-Fort Worth, Texas

St. CharlesMedicalCenter – Bend, Oregon

Mid-ColumbiaMedicalCenter – The Dalles, Oregon

ElkRegionalHealthCenter – Elk, Pennsylvania

St. Peter’s Hospital – Jeanette, Pennsylvania

WindberMedicalCenter – Windber, Pennsylvania

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References

  • Carson, C.F., Hammer, K.A., and T.V. Riley. “Melaleuca alternifolia (tea tree) oil: A review of antimicrobial and other medicinal properties.” Clinical Microbiology Reviews 19, (2006): 50-62.
  • Faoagali, J., George, N., and J.F. Leditschke. “Does tea tree oil have a place in the topical treatment of burns.” Burns 4, (1997): 349-51.
  • Carson, C.F., Cookson, B.D. et al. “Susceptibility of methicillin-resistant staphylococcus-aureus to the essential oil of melaleuca-alternifolia.”Journal of Antimicrobial Chemotherapy 35, (1995): 421-4.
  • Klevens, R.M., Morrison, M.A., et al. “Invasive methicillin-resistant staphylococcus aureus infections in the United States.” Journal of the American Medical Association 298, (2007): 1763-71.
  • Warnke, P.H., Becker, S.T., et al. “The battle against multi-resistant strains: Renaissance of antimicrobial essential oils as a promising force to fight hospital-acquired infections.” Journal of Craniomaxillofacial Surgery, May 25, 2009.
  • Caelli, M., Porteous, J., et al. “Tea tree oil as an alternative topical decolonization agent for methicillin-resistant staphylococcus aureus.” Journal of Hospital Infection 46, (2000): 236-7.
  • Lehrner, J., Marwinski, G., et al. “Ambient odors of orange and lavender reduce anxiety and improve mood in a dental office.” Physiology and Behavior 86, (2005): 92-5.
  • Field, T., Field, T., et al. “Lavender bath oil reduces stress and crying and enhances sleep in very young infants.” Early Human Development 84, (2008): 399-401.
  • Spirling, L.I., and I.R. Daniels. “Botanical perspectives on health peppermint: more than just an after-dinner mint.” The Journal of the Royal Society for the Promotion of Health 121, (2001): 62-3.
  • Kite, S., Maher, E., et al. “Development of an aromatherapy service at a cancer centre.” Palliative Medicine 12, (1998): 171-80.
  • Maddocks-Jennings, W., and Jenny M. Wilkinson. “Aromatherapy practice in nursing: literature review.” Journal of Advanced Nursing 48, (2004): 93-103.
  • Baratta, M.T., Dorman, H.J., Stanley, G.D., et al. “Antimicrobial and antioxidant properties of some
  • commercial essential oils.” Flavour and Fragrance Journal 13 (1998): 235-44.
  • Nakamura, A., Fujiwara, S., Matsumoto, I., et al. “Stress repression in restrained rats by (R)-(-)-Linalool
  • inhalation and gene expression profiling of their whole blood cells.” Journal of Agricultural and
  • Food Chemistry 57, no 12 (2009): 5480-85.
  • Warnke, P.H., Sherry, E., et al. “Antibacterial essential oils in malodorous cancer patients: clinical observations in 30 patients.” Phytomedicine 13, (2006): 463-7.
  • Eccles, R., Griffiths, D.H., et al. “The effects of D and L isomers of menthol upon nasal sensation of airflow.” The Journal of Laryngology and Otology 102, (1988): 506-8.
  • Warnke, P.H., Becker, S.T., et al. “The battle against multi-resistant strains: Renaissance of antimicrobial essential oils as a promising force to fight hospital-acquired infections.” Journal of Cranio-Maxillofacial Surgery 37, (2009): 392-7.
  • Brady, A., Loughlin, R., et al. “In Vitro activity of tea-tree oil against clinical skin isolates of methicillin-resistant and sensitive Staphylococcus aureus and coagulase-negative staphylococci growing planktonically and as biofilms.” Journal of Medical Microbiology 55, (2006): 1375-80.
  • Caelli, M., Porteous, J., et al. “Tea tree oil as an alternative topical decolonization agent for methicillin-resistant Staphylococcus aureus.” Journal of Hospital Infection 46, (2000): 236-7.
  • Groves, Bob. “Healing’s Sweet Scent.” The Record August 1, 2006.
  • Edwards-Jones, V., Buck, R., et al. “The effect of essential oils on methicillin-resistant Staphylococcus aureus using a dressing model.” Burns 30, (2004): 772-7.
  • Warnke, P.H., Sherry, E., et al. “Antibacterial essential oils in malodorous cancer patients: Clinical observations in 30 patients.” Phytomedicine 13, (2006): 463-7.
  • Bagg, J., Jackson, M.S., et al. “Susceptibility to Melaleuca alternifolia (tea tree) oil of yeasts isolated from the mouths of patients with advanced cancer.” Oral Oncology 42, (2006): 487-92.
  • Hammer, K.A., Carson, C.F., et al. “Antimicrobial activity of essential oils and other plant extracts.” Journal of Applied Microbiology 86, (1999): 985-90.
  • Kivanc, M. and A. Akgul. “Antibacterial activities of essential oils from Turkish spices and citrus.” Flavour and Fragrance Journal 1, (2006): 175-9.
  • Wheeler, Jo L., “The Science and Art of Aromatherapy.” Journal of Holistic Nursing 17;5 (1999).

Vanderbilt Wellness Committee

Essential Oil Protocol

Identify metrics for evaluation:

-Enhance the workplace environment.

-Increase energy.

-Decrease Stress.

-Decrease foul odors in the department.

Identify who needs education on initiative:

Wellness Champions

Wellness Committee members

Staff

Physicians

Assign accountability and clear timeline:

Action / Person Assigned / Timeline / Status
Initial Meeting with Brent Lemonds, Administrative Director, Emergency Services / Tonya McBride, Teresa Sturges / April 15, 2010 / Completed
Meet with Dr. Ian Jones, Medical Director, Adult Emergency Services / Tonya McBride, Teresa Sturges / April 15, 2010 / Completed
Meeting with Dr. David Hill, Chief Medical Advisor, Chairman; Scientific Advisory Committee-doTerra International, Dr. Ian Jones and Brent Lemonds / Tonya McBride, Teresa Sturges, Candise Hillman, Ali Grubbs, Dawn Hawley, Ruthie Curbow. / May 11, 2010 / Completed
Initial Wellness Committee Meeting / Tonya McBride, Teresa Sturges, Candise Hillman, Ali Grubbs, Ruthie Curbow. Dr. David Hill / May 11, 2010 / Completed
Meet with Janice Sisco, Manager Adult Emergency Department / Tonya McBride, Teresa Sturges / May 13, 2010 / Completed
Identify and Recruit Committee Members and Super-users / Tonya McBride, Teresa Sturges, Dawn Hawley, Candise Hillman, Ali Grubbs / May 13, 2010 / Completed
Electronic communication to update the Wellness Committee members concerning current progress and rollout timeline / Tonya McBride, Teresa Sturges / May 15, 2010 / Completed
Development of Wellness Committee mission statement, Standard Rollout Process and SWOT Analysis / Tonya McBride, Teresa Sturges, Candise Hillman, Ali Grubbs, Morgan Vero, Lauren McCartney, Diana Alward, Ruthie Curbow. / May 19, 2010 / Completed
Draft of The Standard Rollout document / Tonya McBride, Ali Grubbs / May 19, 2010 / Completed
Development of PowerPoint Presentation introducing The Wellness Committee / Tonya McBride, Teresa Sturges / May 24, 2010 / Completed
Unit Board Presentation / Ali Grubbs / May 25, 2010 / Completed
Potty News Flyers / Teresa Sturges, Tonya McBride / May 26, 2010 / Completed
Secure location for monthly Wellness Committee meeting / Tonya McBride, Alma Catlin / May 27, 2010 / Completed
Introduction of Wellness Committee through Friday Communication / Janice Sisco / May 28, 2010 / Completed
Completion of Final Draft of The Standard Rollout Document. / Tonya McBride, Teresa Sturges, Candise Hillman, Ali Grubbs / June 3, 2010 / Completed
Education of basic Essential Oil Use to all Wellness Committee members / Tonya McBride, Teresa Sturges / June 4, 2010 / Pending
Electronic Communication to all staff introducing The Wellness Committee with PowerPoint Presentation attachment / Tonya McBride / June 4, 2010 / Pending
Begin data collection, surveying staff for a period of 2 weeks prior to going live, to establish measurable outcomes / Survey Task Force / June 7, 2010 / Pending
Go live with essential oil usage/diffusion / Wellness Committee Members / June 21, 2010 / Pending
Feature Wellness Committee in ED Newsletter / Diana Alward / June 30, 2010 / Pending
Continue data collection with post survey, to establish measurable outcomes / Survey Task Force / July 31, 2010 / Pending
Debrief and adjust action plan / Wellness Committee Members / July 23, 2010 / Pending

Development for Sustained Success

  • Monthly Wellness Committee meetings that will include educational training.
  • Establish Wellness Committee guidelines for proper use of Essential Oils.
  • Pilot Wellness initiative study with measurable outcomes to structure a beneficial wellness program.
  • Monthly educational updates for staff.
  • Committee Members will be available as a resource to staff.
  • An Essential Oil Formulary will be readily available in the department.
  • Debrief and adjust action plan based on measured outcomes.

Identify Methods of Content Delivery: See figure 1 for summary.

Change Theory:

Stetler Model Theory-

This theory integrates Evidenced Based Practice with research.

There are five phases: 1) Preparation

2) Validation

3) Comparative evaluation and decision making

4) Translation and Application

5) Evaluation

Knowledge Translation

-provides a framework that may be helpful in considering the challenges that clinicians are likely to face when attempting to implement evidence based practice.

- exchange, synthesis, and ethically sound application of knowledge within a complex system of interactions among researchers and users to accelerate capture of the benefits of research.

Rogers Diffusion of Innovations-

-Behavioral theory that describes the process the user goes through in the adaptation/rejection of new ideas, practices, and technology.

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