The effectiveness of nurse-delivered aromatherapy in an acute care setting.

OBJECTIVE: To examine the use and effectiveness of essential oil therapeutic interventions on pain, nausea, and anxiety, when provided by nurses to patients in acute hospital settings across a large health system. This study expands upon the limited body of literature on aromatherapy use among inpatients. DESIGN: Retrospective, effectiveness study using data obtained from electronic health records. SETTING: Ten Allina Health hospitals located in Minnesota and western Wisconsin. INTERVENTIONS: Nurse-delivered aromatherapy. MAIN OUTCOME MEASURES: Change in patient-reported pain, anxiety, and nausea, rated before and after receiving aromatherapy using a numeric rating scale (0-10). RESULTS: There were 10,262 hospital admissions during the study time frame in which nurse-delivered aromatherapy was part of patient care. The majority of admissions receiving aromatherapy were females (81.71%) and white (87.32%). Over 75% of all aromatherapy sessions were administered via inhalation. Lavender had the highest absolute frequency (49.5%) of use regardless of mode of administration, followed by ginger (21.2%), sweet marjoram (12.3%), mandarin (9.4%), and combination oils (7.6%). Sweet marjoram resulted in the largest single oil average pain change at -3.31 units (95% CI: -4.28, -2.33), while lavender and sweet marjoram had equivalent average anxiety changes at -2.73 units, and ginger had the largest single oil average change in nausea at -2.02 units (95% CI: -2.55, -1.49). CONCLUSIONS: Essential oils generally resulted in significant clinical improvements based on their intended use, although each oil also showed ancillary benefits for other symptoms. Future research should explore use of additional essential oils, modes of administration, and different patient populations.

CE: Incorporating Acupressure into Nursing Practice.

Rooted in traditional Chinese medicine, the use of acupressure to alleviate symptoms, support the healing process, promote relaxation, and improve overall health has grown considerably in the West. The effects of acupressure--like those of acupuncture, with which it shares a theoretical framework--cannot always be explained in terms of Western anatomical and physiologic concepts, but this noninvasive practice involves minimal risk, can be easily integrated into nursing practice, and has been shown to be effective in treating nausea as well as low back, neck, labor, and menstrual pain. The author discusses potential clinical indications for the use of acupressure, describes the technique, explains how to evaluate patient outcomes, and suggests how future research into this integrative intervention might be improved.

Prevention of dimethylsulfoxide-related nausea and vomiting by prophylactic administration of ondansetron for patients receiving autologous cryopreserved peripheral blood stem cells.

PURPOSE/OBJECTIVES: To evaluate the effectiveness of ondansetron for the prevention of nausea and vomiting from dimethylsulfoxide (DMSO) during autologous stem cell transplantation (ASCT) infusion. DESIGN: Nonrandomized cohort using historical control. SETTING: Comprehensive cancer center outpatient infusion department. SAMPLE: 50 patients receiving ASCT in the outpatient setting. METHODS: Patients were assessed for nausea and vomiting on their infusion day using the Multinational Association of Supportive Care in Cancer Antiemesis Tool (MAT) at arrival, pre-ASCT infusion, pre-ondansetron administration, prior to the first bag, and after each bag of stem cells. A standard script was used to ensure consistency. Ondansetron, 16 mg IV, was administered 30-90 minutes prior to each ASCT infusion. Number and volume of stem cells bags, as well as infusion rate and emesis episodes, were recorded. Nausea scores and vomiting episodes were compared to historical data. MAIN RESEARCH VARIABLES: Subjectivity of nausea, potential Hawthorne Effect. FINDINGS: Forty-five percent of patients had an MAT score greater than 2 on arrival, decreasing to 18% after receiving ondansetron before the first bag. Twenty-four percent had MAT increases of more than two points by infusion end compared to 58% in the historic control group. Eighteen percent of patients vomited compared to 28% of historic controls. CONCLUSIONS: The administration of 16 mg of IV ondansetron significantly reduced DMSO-related nausea and episodes of vomiting in patients receiving ASCT. IMPLICATIONS FOR NURSING: Prophylactic administration of ondansetron had a positive effect on reducing nausea symptoms and episodes of vomiting during ASCT infusions. These results prompted a change in clinical practice. More research is required to determine whether the inclusion of other antiemetic agents would provide even greater benefit. KNOWLEDGE TRANSLATION: To date, no other published studies have explored the benefits of premedicating patients with ondansetron prior to ASCT infusions. This study is the first to establish efficacy of ondansetron for an unlabeled indication. These results may pave the way for future research in decreasing nausea and vomiting in this setting.

The effects of P6 acupressure and nurse-provided counseling on chemotherapy-induced nausea and vomiting in patients with breast cancer.

PURPOSE/OBJECTIVES: To evaluate the effects of pericardium 6 (P6) acupressure and nurse-provided counseling on chemotherapy-induced nausea and vomiting (CINV) in patients with breast cancer. DESIGN: Randomized, controlled trial. SETTING: A university cancer center in Seoul, South Korea. SAMPLE: 120 women who were beginning their second cycle of adjuvant chemotherapy after definitive surgery for breast cancer and who had more than mild levels of nausea and vomiting with the first cycle of chemotherapy. METHODS: Participants were assigned randomly into four groups: control (placebo on SI3), counseling only, P6 acupressure only, and P6 acupressure plus nurse-provided counseling. The experiences of upper-gastrointestinal distress were measured by the Rhodes Index of Nausea, Vomiting, and Retching for acute (day 1) and delayed (day 2 to day 5) CINV. MAIN RESEARCH VARIABLES: Nausea, retching, vomiting, P6 acupressure, and counseling. FINDINGS: No significant differences were found in the demographic and disease-related variables among the four groups. The levels of CINV were significantly different among the groups from day 2 to day 5. The CINV differences were attributed mainly to the difference between the control group and the group with P6 acupressure plus nurse-provided counseling. The effects of acupressure were proven from day 2 to day 5, and the effects of nurse-provided counseling were proven on day 4 and were close to significance level on day 5. CONCLUSIONS: Synergic effects of P6 acupressure with nurse-provided counseling appeared to be effective in reducing CINV in patients with breast cancer. IMPLICATIONS FOR NURSING: P6 acupressure combined with counseling by nurses is a safe and easy-to-apply tool in CINV management in practice.

Chemotherapy induced nausea and vomiting: a European perspective.

International guidelines have been available for the successful management of chemotherapy-induced nausea and vomiting (CINV) for several years, yet the experience of patients receiving chemotherapy continues to reflect variable symptom control. This article explores the clinical awareness and application of the guidelines across several European countries from the perspective of the nurses working in oncology units and centres who met at an expert European forum in London in June 2010. It will also identify the existing barriers to the use of best practice guidelines and some of the reasons why clinicians may not be aware of this guidance. There will be some discussion around the use of individualized risk assessments and the prescribing of the most appropriate antiemetic to meet the needs of the individual patient. It will also consider the hospital-produced algorithms and local drug protocols and the limitations on being able to deliver optimal symptom control from day one of cycle one. The role of the nurse in providing holistic care is key to making the experience for chemotherapy patients one to remember, not one they will never forget.

Patterns of symptoms in women after gynecologic surgery.

PURPOSE/OBJECTIVES: To explore patterns of symptoms over time and the relationships between selected demographic and clinical characteristics. DESIGN: Secondary analysis of longitudinal data. SETTING: A hospital and comprehensive cancer center in the northeastern United States. SAMPLE: 66 women with gynecologic cancers, postsurgical, and scheduled to receive chemotherapy. METHODS: A secondary analysis using descriptive and general estimating equation statistical procedures was conducted on symptom and disease data in a subset of a larger nursing intervention study. MAIN RESEARCH VARIABLES: Demographic and clinical variables including cancer site, new diagnosis or recurrence, stage, treatment, comorbidities, emotional distress, use of a symptom management tool kit, and 10 symptoms over time. FINDINGS: Two patterns of symptoms were identified. The first pattern (pain, bowel dysfunction, disturbed sleep, depression, nausea, and lack of appetite) decreased, and the second pattern (fatigue, anxiety, hair loss, and numbness) remained constant over time. The total number of symptoms decreased over time. Factors associated with symptoms, such as the use of a tool kit and emotional distress, were identified. CONCLUSIONS: Tool kit use by women who experienced fatigue, bowel dysfunction, and anxiety suggests its usefulness as a self-care guide. Explanations for the two patterns of symptoms are discussed. IMPLICATIONS FOR NURSING: Postsurgical management should include management and monitoring of symptoms associated with treatment. Screening for emotional distress is recommended in this population. Use of the tool kit could be an effective postsurgical management strategy for women with gynecologic cancers.

Women's responses to nausea and vomiting in pregnancy.

OBJECTIVE: To explore women's experiences of nausea and vomiting in pregnancy. DESIGN: secondary (thematic) analysis of data collected by narrative interviews for two wider studies about antenatal screening and about pregnancy for the DIPEx website (www.dipex.org). PARTICIPANTS AND SETTING: A maximum variation sample was recruited throughout the UK. Data from the 73 women interviewed have been analysed. Interviews took place between October 2003 and December 2004, mostly in the home. FINDINGS: sickness is considered a typical and almost inevitable feature of pregnancy. Against this backdrop, a new framework for understanding women's responses to nausea and vomiting in pregnancy, and the meanings they attach to it, is suggested: nausea and vomiting as something to be expected, survived, resisted, resented, and acknowledged by others. KEY CONCLUSIONS: The concepts of loss of self and biographical disruption from the field of chronic illness seem to resonate with the women's experiences, and may perhaps be extended to transient as well as chronic health conditions. People's experiences of their bodies in health as well as illness need to be more widely studied. IMPLICATIONS FOR PRACTICE: Many women would appreciate greater acknowledgement of the distress nausea and vomiting in pregnancy causes them, information about remedies and strategies other women have found helpful, and reassurance. Expressions of empathy by health-care professionals are frequently lacking and particularly desired.

Nausea and vomiting in pregnancy: what advice do midwives give?

OBJECTIVE: to determine what advice and support midwives give to women experiencing nausea and/or vomiting in pregnancy, with a particular interest in if and how herbal and alternative therapies are prescribed. DESIGN: cross-sectional survey. SETTING: a public, tertiary maternity hospital in Melbourne, Australia. PARTICIPANTS: forty-nine midwives who provide antenatal care. FINDINGS: the advice most commonly given to women experiencing nausea and/or vomiting was to eat frequent small meals and snacks (91%). Other common advice was given by half the midwives or less: avoidance of fatty/spicy foods (53%); eating before rising in the morning, e.g. consumption of dry biscuits/toast (51%); and keeping hydrated (49%). Most midwives (39/46, 85%) included some form of vitamin or herbal supplement in their advice for nausea and vomiting in pregnancy; however, many were unaware of potential harmful side effects or what would constitute appropriate doses. KEY CONCLUSIONS: advice for nausea and vomiting in pregnancy was generally consistent with that documented in the literature. The findings suggest that it is likely that herbal medicines and alternative treatments are often included in common advice given for nausea and vomiting of pregnancy; however, there is little evidence to guide practice in this area. Similarly, common advice for nausea and vomiting in pregnancy is based more on anecdotal evidence than rigorous scientific evidence, highlighting a need for more research in this area. IMPLICATIONS FOR PRACTICE: it is crucial that midwives support women experiencing nausea and vomiting in pregnancy, and that the issue is not treated as merely something women need to 'cope with' as part of pregnancy. Advice given to pregnant women needs to include what is known about the safety and efficacy of various treatments in pregnancy, so they can make informed choices. There is a need for increased awareness of the issues around the safety and efficacy (or otherwise) of herbal supplements and alternative treatments when prescribed or used during pregnancy, and midwives need to be aware of the evidence for any treatment or supplement they suggest to women. Due to the small size of this study and the lack of other literature on this topic, further research would be of benefit.

The nurse's role in day surgery: a literature review.

AIM: This paper reports a literature review to synthesize the evidence on day surgery, demonstrating its usefulness for innovative nurses. BACKGROUND: Day surgery growth has developed rapidly in recent years. Such a rapid growth has triggered a shift in nursing roles and interventions. Nursing roles are taking shape within modern day surgical units but have not been widely reviewed in developing countries. METHODS: The RCN library, BNI, CINAHL and Medline databases were searched using the terms 'day surgery and technological advantages', 'financial/economic benefits', 'patient experiences/satisfaction', 'day surgery/international comparisons', 'day surgery and developing countries'. Only papers in the English language from 1990 to 2005 were reviewed, with a predominantly adult focus. The papers examined mainly used research techniques and some opinion papers, policy documents and textbooks were examined for additional information. FINDINGS: The key strengths of day surgery are cost-effectiveness, increased patient satisfaction and low infection rates. Patients indicated that effective information provision and psychological preparation helped them cope with the experience. The use of music, story telling and distraction reduced pre-operative anxiety. Contrastingly, the deficits included poor information giving and psychological preparation resulting in high anxiety levels. Many patients encountered variable pain and nausea management and education strategies. CONCLUSION: This review highlights the importance of adequate preparation and continuous psychological support for patients undergoing day surgery. The challenges faced by practitioners involved with innovation are also emphasized.

Literature review: should nursing take aromatherapy more seriously?

Aromatherapy is often misunderstood and consequently somewhat marginalized. Because of a basic misinterpretation, the integration of aromatherapy into UK hospitals is not moving forward as quickly as it might. Aromatherapy in UK is primarily aimed at enhancing patient care or improving patient satisfaction, and it is frequently mixed with massage. Little focus is given to the real clinical potential, except for a few pockets such as the Micap/South Manchester University initiative which led to a Phase 1 clinical trial into the effects of aromatherapy on infection carried out in the Burns Unit of Wythenshawe Hospital. This article discusses the expansion of aromatherapy within the US and follows 10 years of developing protocols and policies that led to pilot studies on radiation burns, chemo-induced nausea, slow-healing wounds, Alzheimers and end-of-life agitation. The article poses two questions: should nursing take aromatherapy more seriously and do nurses really need 60 hours of massage to use aromatherapy as part of nursing practice?

The use of motion sickness bands to control nausea and vomiting in a group of hospice patients.

OBJECTIVE: To explore the potential benefits of using motion sickness bands (MSBs) to control nausea and vomiting in a hospice-based patient population. METHODS: A nonblinded, yearlong observational study. RESULTS: From February 2003 to February 2004, 33 patients entered into the study. The mean age of the study cohort was 67 years, with a predominance of females to males and cancer as the most common admitting diagnosis. Twenty-nine of the 33 patients studied showed a positive response to the intervention for a response rate of 88 percent. CONCLUSIONS: MSBs demonstrated efficacy in controlling nausea and vomiting in a group of hospice patients. Added benefits of patient empowerment and financial savings also were noted. Further study is warranted.

Acupressure for nausea and vomiting in cancer patients receiving chemotherapy.

Practitioners working with patients undergoing chemotherapy regularly encourage them to use acupressure in the form of Sea Bands for the relief of treatment-related nausea and vomiting. This mini-review sets out to uncover and examine the evidence base for this recommendation. A mini systematic review was carried out to identify randomized controlled trials comparing the use of acupressure plus usual care with usual care alone. The population was adult patients receiving cancer chemotherapy. The outcome was nausea or vomiting duration or intensity. Searches on Medline, Embase, AMED, the Cochrane Library, Cancerlit and Cinahl identified two randomized controlled trials involving 482 patients with compared acupressure to no intervention control. The results suggest that acupressure may decrease nausea among patients undergoing chemotherapy but further work is required before conclusively advising patients on the efficacy of acupressure in preventing and treating chemotherapy-induced nausea.

Collaborative care management for a pregnant woman with an ostomy.

Pregnant women with an ostomy face many challenges during the prenatal period. Although these challenges may be present, pregnancy in the ostomate is presented as a continuum of health and wellness in this article. Collaborative care professionals, especially nurses and midwives, are often the most accessible professional sources for health care information, but current research and information on this topic is sparse. Ostomy-related problems that may occur during pregnancy, include: intestinal obstruction, peristomal hernia, pouching problems, including the effect of nausea and vomiting on pouch hydration, stomal retraction, stenosis, or laceration, and stomal prolapse. Three types of ostomies are discussed: continent ileostomies, urostomies and colostomies. A description of the normal characteristic appearance of each is also included. Collaborative care from pre-conception through the post partum period is described with emphasis on teaching self-help techniques such as: special nutritional considerations, how to recognize potential problems, and how to fit and adapt appliances to the changing body form of the patient as the pregnancy progresses. Phenomenologic information about the pregnant ostomate's perceptions about her pregnancy experience is also presented. Psycho-prophylaxis methods of complementary therapy alternatives alleviating nausea and vomiting within pregnancy, as well as the pain of childbirth are also presented. Although nursing/midwifery management of a pregnant ostomy patient is a challenge, those challenges are surmountable and outcomes resemble those found in the general population.

Relaxation and imagery for symptom management: improving patient assessment and individualizing treatment.

PURPOSE/OBJECTIVES: To discuss and describe the role of relaxation and imagery in the care of patients with cancer, including suggestions for enhancing assessment and brief instructions for implementing basic interventions. DATA SYNTHESIS: Relaxation and imagery are commonly used to treat various side effects of cancer and its treatment. The nursing literature often has encouraged nurses to use relaxation and imagery to assist patients in managing pain, nausea, vomiting, and anxiety. Frequently, the literature has presented these techniques as being simple, harmless interventions requiring little assessment, planning, or individualization. CONCLUSIONS: Simplistic, generalized approaches may result in suboptimal treatment or deleterious responses. IMPLICATIONS FOR NURSING PRACTICE: Clinicians must assess and collaborate with patients in developing an appropriate strategy that fits the individual's preferences and beliefs.

Acupressure for nausea: results of a pilot study.

PURPOSE/OBJECTIVES: To compare differences in nausea experience and intensity in women undergoing chemotherapy for breast cancer between those receiving usual care plus acupressure training and treatment and those receiving only usual care. DESIGN: Single-cycle, randomized clinical trial. SETTING: Outpatient oncology clinic in a major teaching medical center and a private outpatient oncology practice. SAMPLE: Seventeen women participated in the study. The typical participant was 49.5 years old (SD = 6.0), Caucasian (59%), not married/partnered (76%), on disability (53%), born a U.S. citizen (76%), and heterosexual (88%); lived alone (59%); had at least graduated from high school (100%); and had an annual personal income of $50,000 or greater (65%). METHODS: The intervention included finger acupressure bilaterally at P6 and ST36, acupressure points located on the forearm and by the knee. Baseline and poststudy questionnaires plus a daily log were used to collect data. MAIN RESEARCH VARIABLES: Nausea experience measured by the Rhodes inventory of Nausea, Vomiting, and Retching and nausea intensity. FINDINGS: Significant differences existed between the two groups in regard to nausea experience (p < 0.01) and nausea intensity (p < 0.04) during the first 10 days of the chemotherapy cycle, with the acupressure group reporting less intensity and experience of nausea. CONCLUSIONS: Finger acupressure may decrease nausea among women undergoing chemotherapy for breast cancer. IMPLICATIONS FOR NURSING PRACTICE: This study must be replicated prior to advising patients about the efficacy of acupressure for the treatment of nausea.

A pilot study of the use of progressive muscle relaxation training in the management of post-chemotherapy nausea and vomiting.

The aim of this pilot study was to assess the effectiveness of using progressive muscle relaxation training (PMRT) in the management of chemotherapy-related nausea and vomiting in Chinese breast cancer patients receiving doxorubicin and cyclophosphamide as well as feasibility issues for a larger study. Eight patients were randomly assigned to receive either oral anti-emetics as per hospital protocol (maxolon) or adjuvant PMRT. Both groups, however, received intravenous anti-emetics half an hour before the chemotherapy administration. PMRT was given by a trained nurse once a day for 5 days. A repeated measures design was used. Nausea and vomiting were assessed with the Morrow Nausea and Vomiting Scale. Results indicated that the duration and intensity of nausea were lower in the experimental group, although the former was at a borderline level of significance. The duration and intensity of vomiting were also lower in the experimental group. Delayed nausea and vomiting was observed in both groups. Despite the small sample size, the study showed that PMRT is an effective adjuvant method to decrease nausea and vomiting in chemotherapy patients. This has implications for nursing practice, as it is a low-cost and easy-to-leam technique that can be incorporated in the care planning of patients receiving chemotherapy.

Using acupuncture and acupressure to treat postoperative emesis.

Interest in non-pharmacological strategies to manage health-care problems is increasing. Effective treatment for postoperative nausea and vomiting continues to be elusive, despite the introduction of new anti-emetic drugs. Acupuncture and acupressure might offer an effective, safe, simple and cheap therapy.

Transcutaneous electrical nerve stimulation as an adjunct for controlling chemotherapy-induced nausea and vomiting in gynecologic oncology patients.

BACKGROUND: To evaluate the efficacy of a miniaturized portable transcutaneous electrical nerve stimulation (TENS) unit (ReliefBand) as an adjunct to standard antiemetic therapy for controlling nausea and vomiting induced by cisplatin-based chemotherapy in gynecologic oncology patients. METHODS: Forty-two patients were enrolled in a randomized, double-blind, placebo-controlled parallel-subjects trial with a follow-up crossover trial. All patients received a standardized antiemetic protocol, then wore the ReliefBand continuously for 7 days. RESULTS: Thirty-two patients were evaluable for the parallel-subjects component, 16 in each group. The percentage of patients with absent or minimal nausea was 59% overall, which was similar to that for both the active (56%) and placebo (62%) groups. The incidence and severity of nausea and vomiting was similar for each group. Eighteen patients completed two consecutive cycles and were evaluable for the crossover component. The average age of the crossover patients and their dose intensity were comparable with those of the overall study population (56.3 versus 58.6 years and 22.7 versus 22.7 mg/m2/week, respectively). The percentage of cycles with absent or minimal nausea was 47% overall, which was similar to that of the active (50%) and placebo (44%) cycles. However, the severity of nausea was significantly lower in the active cycles during days 2 to 4. Patients averaged less than one episode of vomiting daily in each cycle. CONCLUSIONS: The ReliefBand is an effective adjunct to standard antiemetic agents for controlling nausea induced by cisplatin-based chemotherapy in gynecologic oncology patients.