Improvement Stories

Promoting Comfort in Labor:
Aromatherapy as a Care Intervention

Contributor:
Katherine Todd, PN, DNP
Clinical Nursing Director
Family Birth Center, Park Nicollet’s Methodist Hospital

What did you set out to change or improve?
The goal was to implement aromatherapy as a care intervention for women delivering their babies at Park Nicollet’s Methodist Hospital Family Birth Center.We sought to offer natural, supportive and evidence based interventions to our birthing population in order to increase our patient centered approach and decrease pharmaceutical interventions. Aromatherapy was chosen as an integrative first step to add to the “tool kits” of our midwives, obstetricians and nurses and launched in 2011.

How did you change it? What new process or practice did you put in place?
We began offering educational and experiential opportunities to all staff (including nursing assistants, unit secretaries, housekeeping) to simply experience aromatherapy themselves. The first step was to create an evidence based aromatherapy policy and present for approval to the various organizations governing committees and senior leaders. Once a policy was approved leadership worked directly with Wyndmere, the manufacturer, to establish a contract for aromatherapy products and educational support. I then insured the proper documentation location and procedure information was in our electronic health record. Once the foundation was ready to support aromatherapy we introduced it to the staff with the sole purpose of offering aromatherapy as a support for treating stress, fatigue and burnout. Staff quickly became familiar and enthusiastic about using aromatherapy personally, and began requesting to be able to offer it to their patients. At that point, leadership created a webinar educational presentation and which all staff completed. We introduced a single essential oil to start, and lavender aromatherapy became our first “go live” therapy and thus the first integrative therapy used to enhance relaxation, calming nervous tension and decreasing stress. We purchased single use, convenient and pre-dosed patches to insure accessibility in every patient room and ease of implementation for staff. We slowly began to grow our aromatherapy options, adding spearmint to address digestive issues and mental fatigue, and mandarin for uplifting and to relieve tension. Since that time we have expanded our integrative approaches to include massage, hydrotherapy, music therapy, guided imagery, and the creation and preservation of healing patient space.

Who was involved in making the change and what was each person’s role?
The Family Birth Center Nursing Director Katherine Todd began the campaign and as the champion of this initiative, was vital in creating and spreading the information through the Park Nicollet organization to gain approval. It was not long before the Unit Based Quality Team (UBQT) on the Family Birth Center began to take interest and joined the movement to bring this and other integrative therapies to the patients. This nursing lead team partnered closely to roll the initiative out to our staff and patients. The Spiritual Care department has also become ambassadors for integrative therapies and are now using them with the patients they worked with as well.

How did you determine if the change worked?
We have tracked our patient satisfaction scores (NRC Picker) both pre and post implementing aromatherapy and found an immediate increase in scores that have not only been sustained over the last several years, but increased with each new offering. Nursing satisfaction scores and joy at work indicator (NDNQI annual survey) have also continued to increase since introducing our first aromatherapy interventions. And while the data do reflect the impact of integrative therapies for both patients and staff alike, the staff reports not needing to see the metrics to appreciate the impact at the bedside. Our patients are happier with their care and the change is palpable. Changes are visible in the looks on women’s faces, the lower reported pain levels and fewer requests for pain medications. It empowers patients’ sense of control, and provides transient stress relief for loved ones at the bedside. Aromatherapy is clearly an essential part of our integrative therapy initiative and has made a significant impact on the Methodist Family Birth Center patient population.

What was the biggest barrier to making the change?
The biggest barrier to making this change was creating and then gaining approval for the aromatherapy policy. Launching aromatherapy required presenting the evidence base to numerous committees and to senior leaders, which although successful, was time consuming and required patience and persistence. The next challenge was simply taking the time necessary to allow, invite and enable the staff to feel safe and confident with utilizing aromatherapy as an integrative and effective tool before discussing implementing the program with patients. A fully engaged team supportive of the intervention. and taking the time to gain buy in from individual care providers was key to our success.

How did you overcome that barrier?
Creating a strong, flexible and enthusiastic evidence based presentation, elevator speech and SBAR that could capture the importance of beginning to use aromatherapy as an intervention was key to getting the policy approved and embraced. Then we offered personal experiences to staff along with the evidence, effectiveness, and therapeutic value for personal and patients use. Enlisting a champion and respected leaders in the unit was critical in providing support and information to staff. Most helpful to overcoming skepticism was simply inviting staff to use it for themselves during stressful shifts.

If you have data or other evidence that your change was successful, please provide that data.

If you had one piece of advice for someone who wanted to make a similar change, what would it be?
The first piece of advice for initiating a new change is to designate a project champion who is passionate and well versed on the change proposed. This champion must be a trusted resource that has the influence to inspire the staff to become open minded and welcome to trying new ideas. Providing a safe and non-intimidating introduction with the ability to have personal experiences with the project was also a fantastic way to gain acceptance and a willingness to learn more.