Efficacy of Lavender in a Hospital Setting

Overview of Research

Presented by
Myra Bonhage-Hale M.S.W. La Paix Herb Farm, Alum Bridge West Virginia
West Virginia Herb Association Fall Conference 2003

Group Studied Tests Used Interventions Results
1) Tysoe, etal: Staff of Extended Care Ward of 25 beds, Nursing, Medical, Volunteers & Support Service Staff. 25 – 1st questionnaire returned

20 – 2nd questionnaire returned. UK.

1) Questionnaire of 1 page containing quantitative and qualitative questions. 1) Essential Oil of lavender used in two burners for 3 month period between questionnaires 1 and 2. One at Nurse’s station, the other in the sitting, social area of clients.

Burnt on early shift and late shift.

1) Before: 88% thought lavender would give positive effect.

2) After: 85% thought lavender was a positive effect.

2) Itai, etal:

14 female inpatients with chronic renal failure gave informed consent. Hospitalized for hemodialysis at Hirosake Hospital, Japan.

All 14 patients included in this study met the criteria for mild to severe depression.

2) HAMD & Hamilton Rating Scale for depression. HAMA Hamilton rating scale for anxiety; CMI test, Cornell Medical Index Test; YG test, & Yatabe-Gilford Test 2) Smells in patients rooms were changed at 1 week intervals from control conditions (natural smell) to odorless conditions using Epolion N-200, from control conditions to aromatic conditions using lavender and from control conditions to aromatic condition using hiba oil. 2) Lavender had a sedative effect on the central nervous system. It is reasonable, therefore, to expect that fragrance may have antidepressant and anxiolytic effects. Further study with a larger # of patients is needed in order to determine how the usual smell in hospital bedrooms and odorless conditions affect patient’s psychological status. Hiba oil has both antidepressant and anti anxiety effects in chronic hemodialysis patients, while lavender has anxiolytic effects in such patients, regardless of presence of physical complications.
3) Ballard etal.

72 subjects with clinically significant agitation from 8 National Health Service nursing homes in the United Kingdom enrolled in the four-week study.

3) Symptoms of agitation, such as anxiety and irritability, motor restlessness and abnormal vocalization, were assessed using the Cohen-Mansfield Agitation Inventory (CMAI). Primary outcome measure was the change in total CMAI score Neuropsychiatry Inventory (NPI) secondary outcome indicators. 3) Melissa (lemon balm) essential oil was dispensed in metered does of 0.16 to 0.17 grams of lotion. A caregiver applied the lotion (Melissa oil in inert base lotion with sunflower oil) topically to subject’s face and arms twice daily for a total of six doses a day. Each subject received a total of 200 mg. each day. The process of gently applying cream to the skin took approximately one to 2 minutes to complete. 3) During the trial, improvements were noted in the areas of physical non-aggressive agitation (motor restlessness) verbal non-aggression (shouting, screaming) and physical aggressiveness. Reduction in time spent socially withdrawn and increase in time engaged in constructive activities among participants in the active treatment group. In addition to using Melissa oil, Chenoweth recommends that people who have dementia depending on their health status and behaviors, might benefit from other natural agents with calming properties, such as lavender, geranium, orange or mandarin.
4) Edge, etal.

8 subjects specifically referred for aromatherapy. Lavender Day Hospital West Sussex, UK

4) HAD Hospital Anxiety and Depression Scale prior to first massage and after the final massage. Subjects’ level of mood, anxiety and relaxation were recorded using a visual analogue before and after each massage and then again 6 weeks after the last massage. 4) Comparison was made between the HAD massage and also first massage and 6 weeks post massage for the sample group. Each massage session was of 1 hour duration. Massage performed same time of day and day of the week for each client. A specific room was allocated for aromatherapy use. Each client received the same standardized massage technique from the same therapist although the essential oils were selected and blended specifically for each session/individual client. The therapist, Jenny Edge, is an Occupational Therapist with 12 years experience of working in the NHS and holds an Int’l Fed. Of Aromatherapists Diploma in Aromatherapy…London. 4) Improvements were shown in six out of eight subjects’ HAD Scale results. Improvements were also shown in all areas when comparing the visual analogue scale results. The study was carried out over an 8 month period.

50% improvement in level of relaxation anxiety. 30% improvement in mood – between rating scales complete ed before and after each massage.

5) Holmes, etal.

15 patients meeting ICD-10 diagnostic criteria for severe dementia and suffering from agitated behavior defined as a minimum score of three points on the Pittsburgh Agitation Scale (PAS)

5) PAS Pittsburgh Agitation Scale 5) A 2% lavender oil aromatherapy stream was administered on the ward for a two hour period alternated with placebo (water) every other day for a total of ten treatment sessions. 5) For each subject 10 total PAS scores were obtained. Five during treatment and five during placebo periods. Nine patients (60%) showed an improvement, five (33%) showed no change and one patient (7%) showed a worsening of agitated behavior during aromatherapy compared with placebo. A comparison of the group median PAS scores during aromatherapy showed a significant improvement in agitated behavior during aromatherapy compared with placebo. Conclusions: Lavender oil administered in an aroma stream shows modest efficacy in the treatment of agitated behavior in patients with severe dementia.
6) Kowalski,

17 cancer hospice patients.

Univ. of Nevada, Las Vegas USA

6) Vital signs as well as levels of pain, anxiety, depression and sense of well-being were measured using 11 point verbal analogs. 6) Each subject was measured in three different days before and after a 60 minute session consisting of 1. no treatment (control). 2. water humidification (control); or 3. 3-percent lavender aromatherapy. 6) Results reflected a positive, yet small, change in blood pressure and pulse, pain, anxiety, depression and sense of well-being after both the humidified water treatment and the lavender treatment. Following the control session (no treatment) there was also slight improvement in vital signs, depression and sense of well being, but not in pain or anxiety levels.
7) Buckle J.

Oxford Brookes UK.

7) Report provides tables with information about essential oils and application methods. 7) Author believes aroma-therapy is a tool for holistic nursing that appears to enhance pain control and could prove to be a useful addition to peri-anesthesia nursing practice.
8) Campbell etc. Aromatherapy in a cancer setting. 8) The need to develop guidelines for the use of aromatherapy was identified to ensure safe and appropriate use in clinical practice. Therapeutic actions and safety data are reviewed along with literature e relating to nurses’ use of aromatherapy. A policy was developed with the needs of the oncology patient being the foremost consideration. Methods of administration and dosage of essential oils were stipulated to address safety issues.
9) Ching, M

Deakin Univ. Burwood

9) This paper examines critically the potential uses of aromatherapy in the management of acute post-operative pain. In order to achieve best practice, further research is necessary to explore the use of aromatherapy in the management of acute post operative pain. (Review of literature, methods of administration and therapeutic effect.)
10) Chu etal.

Longwood Herbal Task Force and The Center for Holistic Pediatric Education and Research

This is a very complete review of the literature overview of the use of lavender. Potential Clinical Benefits:

Cardiovascular (angioprotectant). Pulmonary (expectorant, Renal and Electrolyte balance (no data Gastrointestinal/hepatic, Neuro-psyhiatric (sedative/hymnotic,anxiolytic,anticonvulsant, effects on mood, effects on cognitive function analgesic. Endocrine, hypoglycemic effects, Rheumatologic; Reproductive: emmenagogue, aphrodisiac, perineal repair, Immune modulation: anti inflammatory, Antimicrobial: antibacterial, antifungal, insecticide; Antioxidant, Hair growth stimulant.

11) Hartman etal Tri-County Hospital Wadena Minn USA

five patients with chronic wounds

11) 11) 11) This article describes the progress and problems of a small study of five patients, who were treated with lavender and chamomile essential oils.

Abstract only available.

12) Morris, N.

80 women not receiving treatment for psychological disorders who were staff or students at Univ. of Wolverhampton.

40 participated in Study 1 and 40 in Study 2.

12) Study 1. UWIST mood adjective checklist.

Study 2 the MacLeod and Byrne Future Events Procedure.

12) Participants were randomly allocated to use either grapeseed oil or 80% grapeseed oil and 20% lavender oil in their bath for 14 days. 12) In Study 1 psychologically positive mood changes were found after the bathing regimen for energetic arousal, tense arousal, hedonic tone and anger-frustration. Only anger-frustration showed a selective effect for lavender oil. In the second study negative responses about the future were selectively reduced after lavender oil baths. Conclusions; These results are encouraging and suggest further investigation using potential patients may result in the development of a useful procedure for improving psychological well being.
13) Motomura N One group of 14, analogous group of 15, one group of 13 Japanese version of Cox and Mackay’s stress/arousal adjective checklist for three groups was studied. One group of 14 was placed into a sound protected room for 20 min without the presentation of any odor, an analogous group of 15 received the odor oil and one group of 13 received a nonstressful condition. 13) Analysis suggested that lavender odorants were associated with reduced mental stress and in creased arousal rate.
13) Styles, JL

Pediatric Unit, St. Mary’s Hospital, London UK

Styles proposes the use of Aromatherapy massage to induce relaxation and reduce the stressful aspects of hospitalization of children with HIV disease.

Complete citations for the Research and Papers herein are contained in the Reference Section of this Presentation.

References – The Efficacy of Lavender in a Hospital Setting

Presentation by Myra Bonhage-Hale M.S.W. for

The West Virginia Herb Association Fall Conference 2003 – October 17th, 2003

www.lapaixherbfarm.com

Dementia/Psychiatric Disabilities/Alzheimer’s Disease

  1. Rosen, J., Burgio, L. Kollar, M.. Cain, M. Allison, M. Fogleman, M., et.al. (1994). The Pittsburgh Agitation Scale: a user friendly instrument for rating agitation in dementia patients. Am J Ger Psych, 2, 52-59. (Journal Article)
  2. Steele, C., Rovner, B., Chase, G.A., & Fols tein, M. (1990). Psychiatric symptoms and nursing home placement of patients with Alzheimer’s disease. Am J Psychiatry, 147, 1049-1051. (Journal Article)
  3. Vance, D., (1999) Considering olfactory stimulation for adults with age-related dementia. Percep Mot Skills, 88, 398-400. (Journal Article)
  4. £ MacMahon, S., & Kermode, S. (1998). A clinical trial of the effect of aromatherapy on motivational behavior in a dementia care setting using a single subject design. Aust J Holist Nurs, 5, 47-49. (Journal Article)
  5. £ Brooker, D.J., Snape, M., Johnson, E., Ward, D… & Payne, M. (1997). Single case evaluation of the effects of aromatherapy and massage on disturbed behavior in severe dementia. Br J Clin Psychol, 36, 287-296. Psyc INFO Record: 1997-04602-011 (Journal Article).
  6. Buchbauer, G., Jirovetz, L., Jager, W., Dietrich, H., & Plank. C. (1991). Aromatherapy: evidence for sedative effects of the essential oil of lavender after inhalation. Z Naturforsch C, 46, 1067-1072. (Journal Article).
  7. Edge, Jennifer, formerly Blakemore, A pilot study addressing the effect of aromatherapy massage on mood, anxiety and relaxation in adult mental health, Lavender Day Hospital Horsham West Sussex, UK (I have the complete paper of 8 pages.)
  8. Holmes, C., Hopkins, V; Hensford C; MacLaughlin V; Wilkinson, D.; Rosenvinge H, University of Southampton, School of Medicine, Community Clinical Sciences Research Division, Memory Assessment and Research Unit, Moorgreen Hospital, Southampton, UK. (I have the complete paper of 4 pages).
  9. £ Itai, T, Amayasu H; Kuribayashi M; Kawamura N; Okada M; Momose A; Tateyama T; Narumi K; Uematsu W; Kaneko S, Dept. of Neurophysiatry, Hirosaki University Hospital Japan. Psychological effects of aromatherapy on chronic hemodialysis patients, Psychiatry Clin Neurosci 2000 Aug; 54(4):393-7 (ISSN: 1323-1316)

Infant Care – Animals

  1. £ Kawakami K; Tomonaga M; Suzuki J. The calming effect of stimuli presentation on infant Japanese Macaques (Macaca fuscata) under stress situation: a preliminary study. Primates 2002 Jan; 43(1):73-85.

Hospice Patients

  1. £ Kowalski SD, Louis M, Department of Nursing, Univ. of Nevada, Las Vegas, USA. Use of aromatherapy with hospice patients to decrease pain, anxiety and depression and to promote an increase sense of well being. Am J Hosp Palliat Care. 2002 Nov-Dec. 19(6):381-6.

Nursing Staff

  1. £ Tysoe P, The effect on staff of essential oil burners in extended care settings. Int J Nurs Pract 2000 Apr;6(2):110-2.

Research Criteria

  1. £ Martin GN. Olfactory remediation: current evidence and possible applications. Soc Sci Med. 1996 July:43(1)63-70. “suggestions for improvement in methodology and experimental design.

Abstracts of Important Research

An M; Hai T; Hatfield P, Environmental and Analytical Laboratories, Charles Sturt Univesity, Wagga Wagga, NSW, Australia. man@csu.edu.au.

On site field sampling and analysis of fragrance from living lavender (lavandula angustifolia L.) flowers by solid-phase microextraction coupled to gas chromatography and ion-trap mass spectrometry.

Solid-phase microextraction coupled to gas chromatography and mass spectrometry has been applied as a simple alternative method for the analysis of essential oil directly from lavender intact flowering spikes and genuine oils. All recognized major oil constituents were detected by this procedure with results comparable to those given by a conventional method (organic solvent extraction) Distinctive chromatographic profiles were found for various species. (Journal Article)

Buckle, J., Aromatherapy in perianesthesia nursing., J Perianesth Nurs. 1999 Dec;14(6):336-44. Oxford Brookes University, United Kingdom.

Complimentary therapies are being used by nurses across America to enhance patient care. Aroma-therapy is a tool for holistic nursing that appears to enhance pain control and could prove to be a useful addition to peri-anesthesia nursing practice. This report addresses the emergence of non-conventional therapies and examines the potential role for aroma-therapy in per-anesthesia pain management. Tables provide information about essential oils and applications methods.

Campbell L, Pollard A, Roeton C. Peter MacCallum Cancer Institute, St. Andrews Place, East Melbourne. The development of clinical practice guidelines for the use of aromatherapy in a cancer setting. Aust J Holist Nurs 2001 Apr;8(1):14-22.

The need to develop guidelines for the use of aromatherapy was identified to ensure safe and appropriate use in clinical practice. Therapeutic actions and safety data were reviewed along with literature relating to nurses’ use of aromatherapy. A policy was developed with the needs of the oncology patient being the foremost consideration. Methods of administration and dosage of essential oils were stipulated to address safety issues.

Cavanagh HM; Wilkinson JM, School of Biomedical Sciences, Charles Sturt Univ., Wagga Wagga NSW 2678, Australisa, Biological activities of lavender essential oil. Phytother Res 2002 Jun;16(4):301-8 (ISSN: 0951-418X)

Essential oils distilled from members of the genus Lavandula have been used both cosmetically and therapeutically for centuries with the most commonly used species being L. angustifolia, L. latifolia, L. stoechas and L. x intermedia. Although there is considerable anecdotal information about the biological activity of these oils much of this has not been substantiated by scientific or clinical eveidence. Among the claims made for lavender oil are that is it antibacterial, antifungal, carminative (smooth muscle relaxing), sedative, antidepressive and effective for burns and insect bites. In this review we detail the current state of knowledge about the effect of lavender oils on psychological and physiological parameters and its use as an antimicrobial agent. Although the data are still inconclusive and often controversial, there does seem to be both scientific and clinical data that support the traditional uses of lavender. However, methodological and oil identification problems have severely hampered the evaluation of the therapeutic significance of much of the research on Lavandula spp. These issues need to be resolved before we have a true picture of the biological activities of lavender essential oil.

Ching, M. Contemporary therapy: aromatherapy in the management of acute pain?, Contemp Nurse. 1999 Dec:8(4):146-51.

Recent surveys indicate that people are increasingly using complementary therapies as an adjunct or alternative to conventional treatment options as we strive for general health and well being. Whilst complementary therapies such as aromatherapy have been utilized in clinical settings as diverse as long term care facilities and palliative care, its application to the acute care setting has not been explored in depth. The changes in contemporary health care practices such as post-operative pain management and length of hospital admissions have provided nurses with the challenge of examining the range of therapeutic interventions that can be applied to their practice. The purpose of this paper is to examine critically the potential uses of aromatherapy in the management of acturte post-operative pain. The concept of aromatherapy will be explored in relation to its effects on the pain pathways, methods of administration and therapeutic effects. Speciafic reference will be made to Lavender (Lavandula angustifolia) and its use in aromatherapy. A review of the literature points to gaps in the knowledge related to the clinical application of aromatherapy in relation to issues of dosage, methods of administration and therapeutic effect. The relatively small number of studies that have looked at aromatherapy in the acute care setting supports the literature reviewed. Issues such as smallsample sizes and the difficulty in replicating these studies make it difficult to generalize the findings. In order to achieve best practice, further research is necessary to explore the use of aromatherapy in the management of acute post-operative pain.

Chu, Catherine J. and Kemper, Kathi J., MD, MPH, Lavender (Lavandula spp.) The Center for Holistic Pediatric Education and Research http://www.childrenshospital.org/holistic/

and The Longwood Herbal Task Force. http://www.mcp.edu/herbal/

Principal Proposed Uses: Sedative and anxiolytic; antimicrobial

Other Proposed Uses: Analgesic, anticonvulsant, and antidepressant; cholagogue, antispasmodic and digestive aid; antioxidant; anti-inflammatory; cancer chemopreventative; insecticide; aphrodisiac.

Overview: Lavender’s essential oil is commonly used in aromatherapy and massage. Its major clinical benefits are on the central nervous system. Many studies conducted on both animals and humans support it use as a sedative, anxiolytic and mood modulator. Lavender oil has in vitro antimcrobial activity against bacteria, fungi and some insects. Lavender’s essential oil exerts spasmolytic activity in smooth muscle in vivo, supporting its historical use as a digestive aid. Particular chemical constituents of lavender have potent anticarcinogenic and analgesic properties; its antioxidant effects are less potent than those of other members of it s botanical family such as rosemary and sage. Allergic reactions to lavender have been reported. Because of its potent effects on the central nervous system, people with seizure disorders and those using sedative medications should consult a physician before using lavender. Although lavender has traditionally been used to treat symptoms ranging from restlessness to colic in infants and children, systhematic studies have not been conducted to test the efficacy and safety of lavender use in infants and children or during pregnancy or lactation.

Note: This report comprises 30 pages and was revised July 2, 2001. It is a comprehensive report of many research articles. It discusses the botany and chemical compounds. Some of these are: Linalyl acetate and linalool which have sedative and local anesthetic effects; linalool also has antibacterial, antifungal and insecticidal effects. These two compounds are the most prominent chemical constituents in the essential oil of L. angustifolia, accounting for up to 90% of the oil by volume. Following topical application of the essential oil of L. angustifolia, linalyl acetate and linalool can be detected in the blood within five minutes, peak at 19 minutes, and are cleared within 90 minutes. Cineole has antispasmodic and antifungal properties. Eugenol has spasmolytic activity as well as local anesthetic effects. Other constitutents of lavender with antibacterial effects include alpha-terineol and terpenen-4-ol and camphor etc. Different lavender species contain different chemicals in differing proportions. This extensive paper covers Cardiovascular, Pulmonary (Expectorant), Gastrointestinal/hepatic, Cholagogue, Antispasmodic/digestive aid, neuro-psychiatric, Sedative/hypnotic, etc. For the complete 30 page report, please ask Myra – the cost is $15. plus mailing.

Hartman D; Coetzee JC, Tri-County Hospital, Wadena, Minnesota, USA bdhartman@wcta.net Two US practititons experience of using essential oils for wound care. J Wound Care 2002 Sep.;11(8):317-20.

Though essential oils are a proven antiseptic, little work has investigated there use on chronic wounds. This article describes the progress and problems of a small study of five patients, who were treated with lavender and chamomile essential oils.

Johnson GR, Nurse Education Dept. Leeds College of Health. Complementary therapies in nursing. Implications for practice using aromatherapy as an example.

Complement Ther Nurs Midwifer. 1995 Oct; (5):128-32.

This paper explores the use of aromatherapy within nursing. Beliefs and values which may influence nursing are explored and these frequently parallel philosophies that influence complementary therapies. Organizational and professional factors which may influence the use of aromatherapy are considered. The development of policies to guide aromatherapy practice plus identifying the most appropriate person to undertake this care is discussed. Justifying care is explored via the development of research based practice and the generation of appropriate knowledge to guide practice. Although the paper is based on aromatherapy many of the issues raised are relevant to other complementary therapies. Similarly, the word “nurse” is used but the issues all relate to the practice of aromatherapy within midwifery and health visiting.

Morris N The effects of lavender (Lavendula angustifolium) baths on psychological well-being: two exploratory randomized control trials. Complement Ther Med 2002 Dec;10(4):223-8

Objective: Two important aspects of psychological well-being are positive mood state and a positive outlook with respect to the future. This study investigates the use of lavender baths to improve these aspects of psychological well-being. Design: A single blind, randomized control trial. Setting: The participant’s home and interview rooms at the University of Wolverhampton. Participants: Eighty women not receiving treatment for psychological disorders who were staff or students at the University. Forty participated in Study 1 and 40 participated in Study 2. Intervention: Participants were randomly allocated to use either grapeseed oil or 80% grapeseed oil and lavender oil in their bath for 14 days. Main Outcome Measures: In Study 1, the UWIST mood adjective checklist. In Study 2, the MacLeod and Byrne Future Events procedure. Results: In Study 1 psychologically positive mood changes were found after the bathing regimen for energetic arousal, tense arousal, hedonic tone and anger-frustration, Only anger-frustration shoed a selective effect for lavender oil. In the second study negative responses about the future were selectively reduced after lavender oil aths. Conclusions: These results are encouraging and suggest furt her investigation using potential patients may result in the development of a useful produced for improving psychological well-being.

Motomura N; Sakurai A; Yotsuya Y, Dept. of Health Science, Osaka Kyoiku University, Kashiwara City, Japan motomura@cc.osaka-kyoiku.ac.jp Reduction of Mental Stress with lavender odorant. Percept Mot Skills 2001 Dec;93(3):713-8 (ISSN 0031-5125)

The effect of the lavender odorant on a Japanese version of Cox and Mackay’s stress/arousal adjective checklist for three groups was studied. One group of 14 was placed into a 2 x 2 –x 3 m) sound protected room for 20 min without the presentation of an odor, an analogous group of15 received the odor oil and one group of 13 received a non stressful condition. Analysis suggested the lavender odorants were associated with reduced mental stress and increased arousal rate.

Styles JL, Pediatric Unit, St. Mary’s Hospit al, London, UK, The use of aromatherapy in hospitalized children with HIV disease. Complement Ther Nurs Midwifery. 1997 Feb;3(1):16-20.

Aromatherapy has been defined as ‘the art—and science—of using essential oil in treatments ….a truly holistic therapy, taking into account mind, body and spirit…..’ (Davis 1991). Aromatherapy is a valuable means of maintaining optimum health, particularly when the dis-ease of the body or mind is related stress. The process of hospitalization is a potentially stressful experience that has been well researched (Broome etal 1990, Kachoyeanos & Friedhoof 199, Strachan 1993, Taylor 1991). This paper examines the ways in which massage and aromatherapy could be of benefit to hospitalized children, particularly those infected with Human Immunodeficiency Virus (HIV). Wright (1995) states that nurses should encourage self-healing by putting patient in the best condition for nature to act. Aromatherapy massage has the potential to achieve this through inducing relaxation and reducing the stressful aspects of hospitalization. Thus, the author would like to propose the use of this valuable skill as an extension of the nursing role.

Myra Bonhage-Hale, M.S.W. Efficacy of Lavender in a Hospital Setting: Overview of Research

For presentation to the West Virginia Herb Association Fall Conference 2003.

La Paix Herb Farm, 3052 Crooked Run Rd., Alum Bridge, W.V. 26321

(304) 269-7681 www.lapaixherbfarm.com

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