RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

1.NAME OF THE CANDIDATE AND ADDRESS

Mr. DIJO SEBASTIAN1ST YEAR M.SC. NURSINGGARDEN CITY COLLEGE OF NURSING,VIDYANAGAR,K.R. PURAM,BANGALORE, KARNATAKA.

2. NAME OF THE INSTITUTION

GARDEN CITY COLLEGE OF NURSING,VIDYANAGAR,K.R. PURAM,BANGALORE, KARNATAKA.

3. COURSE OF THE STUDY AND SUBJECT

M.SC. NURSING FIRST YEARMEDICAL AND SURGICAL NURSING

4. DATE OF ADMISSION TO THE COURSE

25TH JUNE 2009.

5. TITLE OF THE TOPIC

A STUDY TO DETERMINE THE EFFECTIVENESS OF AROMATHERAPY ON BACK PAIN AMONG THE STAFF NURSES IN A SELECTED HOSPITAL AT BANGALORE.

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

6. BRIEF RESUME OF THE INTENDED WORK:

INTRODUCTION “IF NOT A RULER, BE A HEALER”

Living with pain can be very difficult and overwhelming, especially over a long period of time. The use of natural pain relief remedies such as Aromatherapy essential oils has become very popular, as generally people do not want to take pain killers over an extended period of time as they are addictive and have nasty long term side effects1.

Aromatherapy is a form of alternative medicine that uses volatile plant materials, known as essential oils, and similar aromatic compounds from plants, for the purpose of improving a person's mood, cognitive function or health. Preliminary scientific evidence is growing in all these areas2.

It is used by manufacturers (of personal care, wellness and hygiene products) as well as practitioners, including massage therapists, chiropractors, nurses and doctors3. The aromatherapy benefits on pain relief have been well studied and documented and for many have become the preferred method of healing pain and many common ailments today1.

Essential oils can be used safely to assist with pain relief. There are many different oils which can be used to assist with the relief of pain and discomfort. These pure essential oils can be added to a base oil or cream and rubbed or gently massage into the affected area1. A study on the effectiveness of aromatherapy in reduction of pain and its associated behavioral changes among major abdominal surgery (2008) proves that administration of aromatherapy as complementary therapy to the hospital pain management protocol enhanced the control of pain, behavioral changes and enabled greater comfort and relaxation of the clients4. Hence aromatherapy can be used as safe and inexpensive adjunct to conventional medicine.

The 5 Commonly Used Pure Essential Oils Used For Pain Relief

1. Curry – Helichrysum Italicum is excellent for pain relief as it has antispasmodic and anesthetic properties as well for relief of deep pain.

2. Peppermint - Mentha piperita has been used through the ages for headaches, aches and pains, backache and arthritis. Peppermint has excellent pain relief properties and is also know as a powerful anti-inflammatory.

3. Basil - Ocimum basilicum which is very good for any type of muscle or nerve pain. Basil is excellent muscle relaxant and also contains powerful anti-inflammatory and anti-spasmodic properties as well.

4. Marjoram - Origanum majorana also has muscle soothing properties for any type of muscular or nerve pain and is also very beneficial for headaches.

6.1

5. Clove - Syzygium aromaticum which is well know for relief from toothache. It has analgesic properties along with anti-inflammatory, analgesic properties and anesthetic properties1.

Two basic mechanisms are offered to explain the purported effects. One is the influence of aroma on the brain, especially the limbic system through the olfactory system. The other is the direct pharmacological effects of the essential oils5.

NEED FOR THE STUDY:

Because many essential oils are potent antimicrobials, they can be useful in the treatment of infectious disease. They are used as medicines, often in combination with other herbal preparations. In nursing, essential oils are increasingly used in pain management, anxiety/depression, and Alzheimer's disease. Aromatherapy may be used in combination with other forms of alternative medicine6.

Aromatherapy excels in the remediation of infectious states, improving immune response and regulating neurohormonal imbalances as well as having a positive effect on the psycho-emotional state. Considering this, aromatherapy has much to offer and a wide application in the care of the person challenged with cancer6.

Aromatherapy oils are generally safe and easy to use and people have been successful using Aromatherapy pure essential oil either on there own or combined in a blend to assist with pain relief1. American Pain Society, & American College of Physicians (2007) conducted a study on the effect of aromatherapy for relieving low back pain and good evidence was found that aromatherapy was moderately effective for relieving chronic and subacute low back pain. Fair evidence also found that acupuncture, massage, yoga (viniyoga), and functional restoration are also effective for chronic low back pain.The holistic benefits of combining aromatherapy pure essential oils and massage therapy, is well known to assist with relief from pain and discomfort and is suitable for people of all ages7.

Pain is a result of disease, inflammation, or injury to tissues. It is immediate and usually of a short duration. Acute pain is a normal response to injury and may be accompanied by anxiety or emotional distress. The cause of acute pain can usually be diagnosed and treated. People who stand and work for a long period of time as well as who lift heavy objects usually will have back pain. According to the National pain foundation’s recent study report (2009/OCT) reveals that pain has been considered as the fifth vital sign and 8 out 10 people experience back pain at some point during their lives. Back pain can range from a dull constant ache to a sudden, sharp pain. Untreated and unrelieved pain can cause or contribute to spikes in blood pressure which can lead to heart attacks or strokes.Chronic or acute pain can result in nausea, loss of appetite, difficulty sleeping and disturbances of sleep patterns, drowsiness,

fatigue, difficulty with concentration, increase in depression, anxiety and social

isolation. Chronic pain can affect the body both physically and emotionally8. Nurses usually stand for a prolonged period of time for performing certain procedures and are always with the patient to provide care for them. Especially nurses who work in the ICU have to lift the patient for the necessary procedures and actions. Because of these hectic working schedule nurses may have back pain.Current statistics shows that back pain among staff nurses was highly prevalent with an annual prevalence varying from 73% to 76%9.

Coping with pain or any form of discomfort is emotionally taxing and distressing. Other pure essential oils can be used to help cope with the psychological aspect of dealing with pain including Lavender Oil which is excellent for people who are suffering from emotional pain, anxiety or distress. Lavender promotes a feeling of calmness, confidence and relaxation. Lavender also soothes the spirit and provides relief from anger and exhaustion whilst restoring and healing the body1. Bekker A.Y. (2006).conducted a study on evaluation of aromatherapy in treating postoperative pain, in which he concluded that patients in the lavender group reported a higher satisfaction rate with pain control than patients in the control group10.

The use of essential oils for pain management is becoming an increasingly common means of treating pain . Massage benefits the body for several reasons. Firstly is stimulates the specific nerves that reduce the transmission of pain throughout the body. Secondly, it improves the circulation of blood, which helps people relax and promotes a general feeling of well being which helps people cope with their pain more readily. Thus promoting aromatherapy to alleviate back pain among staff nurses would render better nursing care to the patients11.

6.2 REVIEW OF LITERATURE

The review of literature were presented under the following heading.

A) Review related to aroma therapy

B) Review related to effect of aroma therapy on back pain

A) Review related to aromatherapy

P. Ponnarasi, (2008) has done a study on the effectiveness of aromatherapy in reduction of pain and its associated behavioural changes among major abdominal surgery patients. The simple random sampling technique was used to select the 60 samples for the study. The study result signifies that administration of aromatherapy as complementary therapy to the hospital pain management protocol enhanced the control of pain, behavioural changes and enabled greater comfort and relaxation of the clients. Hence, aromatherapy can be used as safe and inexpensive adjunct to conventional medicine4.

Shin, B.C., Lee, M.S. (2007) conducted a study on effects of aromatherapy acupressure on hemiplegic shoulder pain and motor power in stroke patients Stroke patients with hemiplegic shoulder pain were randomly assigned to either an aromatherapy acupressure group or an acupressure group with aromatherapy acupressure using lavender, rosemary, and peppermint. Each acupressure session lasted 20 minutes and was performed twice-daily for 2 weeks. The result explained that the pain scores were markedly reduced in both groups at post-treatment, compared to pretreatment. The motor power significantly improved at post-treatment, compared to pretreatment in both groups12.

Wilkinson, S, et.al (2007) have done a study on effectiveness of aromatherapy massage in the management of anxiety and depression in patients with cancer.Two hundred eighty-eight cancer patients referred to complementary therapy services with clinical anxiety and/or depression, were allocated randomly to a course of aromatherapy massage or usual supportive care alone. Patients who received aromatherapy massage had lower anxiety and depression compared with those receiving usual care 6 weeks postrandomization. Patients receiving aromatherapy massage also described greater improvement in anxiety at both 6 and 10 weeks postrandomization13.

Kim, J.T, et.al; (2006) briefly reports about evaluation of aromatherapy in treating postoperative pain. This study compared the analgesic efficacy of postoperative lavender oil aromatherapy was given to patients undergoing breast biopsy surgery. Result signifies patients in the lavender group reported a higher satisfaction rate with pain control than patients in the control group14.

Burnett, K.M, et.al; (2004). Reported a study on scent and mood state following an anxiety-provoking task. The purpose of this study was to assess the effects of water, lavender, or rosemary scent on physiology and mood state following an

anxiety-provoking task. Measures of external temperature and heart rate were taken

prior to introduction of an anxiety-eliciting task and exposure to lavender, rosemary, or water scents. Following the task, participants completed the Profile of Mood States to assess mood, and temperature and heart rate were reassessed. Participants rated the pleasantness of the scent received. The study showed that when pleasantness ratings of scent were covaried, physiological changes in temperature and heart rate did not differ based on scent exposure, but mood ratings differed by scent condition. Participants in the rosemary condition scored higher on measures of tension-anxiety and confusion-bewilderment relative to the lavender and control conditions. The lavender and control conditions showed higher mean vigor-activity ratings relative to the rosemary group, while both rosemary and lavender scents were associated with lower mean ratings on the fatigue-inertia subscale, relative to the control group15.

Sayette, M.A. & Parrott, D.J. (1999) done a study on effects of olfactory stimuli on urge reduction in smokers. This study examined the possibility that exposure to olfactory stimuli can reduce self-reported urge to smoke. After an initial assessment of self-reported urge, nicotine-deprived smokers evaluated the pleasantness of a series of 8 odors. Facial expressions during odor presentations were coded with P. Ekman and W. V. Friesen's Facial Action Coding System. After odor administration, participants were exposed to smoking cues. Next, participants were administered their most pleasant, least pleasant, or a control odor (water) and reported their urge to smoke. Results indicated that sniffing either a pleasant or unpleasant odor reduced reported urge to smoke relative to the control odor. Reported pleasantness of the odors did not differentially affect urge reduction. Odors eliciting negative-affect-related expressions, however, were less effective than odors that did not elicit negative-affect-related expressions in reducing reported urge. Results of this preliminary investigation provide support for the consideration of odor stimuli as an approach to craving reduction16.

B) Review related to effect of aroma therapy on back pain Corinna Underwood [ 2008 ] reported that Chamomile is an essential oil with very effective anti-inflammatory properties. It is great for easing the pain of headaches, migraine, neck tension and shoulder pain. It is also soothing for digestive discomfort, lower back pain and menstrual cramps.Lavender is one of the best essential oils for pain relief. It’s great for relieving muscle cramps and strains, headache, neuralgia, Lavender can also help to calm nervous tension and to relieve mood swings.Sandalwood is recognized in Ayurvedic medicine as being a very valuable essential oil for pain management. It soothes muscle tension by improving the circulation and is beneficial for back pain, neuralgia and sciatica. Sweet marjoram essential oil has potent sedative effects. It also soothes muscle stiffness and cramp, improves circulation and eases the symptoms of rheumatism and osteoarthritis. It is also effective for treating headaches, migraine and menstrual cramps.Vetiver relieves arthritis, muscle ache, pain, sprain and stiffness, but circulation so it helps to detoxify tissues. It balances the central nervous system and is beneficial for tension and depression. Each of these oils, apart from lavender has a high potency so only 3-

4 drops are required in a blend. They each mix well with citrus oils which are soothing or flower oils which help clear the mind17.

Willem J.J Assendelft MD, PhD; { 2007 } this study has been done to resolve the discrepancies related to use of aromatherapy and to update previous estimates of effectiveness by comparing aromatherapy with other therapies and then incorporating data from recent high-quality randomized, controlled trials (RCTs) into the analysis. Randomized, controlled trials of patients with low back pain that evaluated aromatherapy with at least 1 day of follow-up and at least one clinically relevant outcome measure. This study concluded that there is no evidence that aromatherapy is superior to other standard treatments for patients with acute or chronic low back pain18.

Chou, R., Huffman, L.H., American Pain Society, & American College of Physicians. (2007) done a study on nonpharmacologic Therapies for Acute and Chronic Low Back Pain. Information was abstracted about study design, population characteristics, interventions, outcomes, and adverse events. Good evidence was found that cognitive- behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation are all moderately effective for chronic or subacute low back pain. Fair evidence also found that acupuncture, massage, yoga (Viniyoga), and functional restoration are also effective for chronic low back pain19.

Daniel C. Cherkin, PhD;et.al; [2003] Conducted a study to provide a rigorous and balanced summary of the best available evidence about the effectiveness, safety, and costs of the most popular complementary and alternative medical therapies used to treat back pain. Two authors independently extracted data from the reviews (including number of RCTs, type of back pain, quality assessment, and conclusions) and original articles (including type of pain, comparison treatments, sample size, outcomes, follow-up intervals, loss to follow-up, and authors’ conclusions). They concluded that initial studies have found massage to be effective for persistent back pain. Spinal manipulation has small clinical benefits that are equivalent to those of other commonly used therapies. The effectiveness of acupuncture remains unclear. All of these treatments seem to be relatively safe. Preliminary evidence suggests that massage, but not acupuncture or spinal manipulation, may reduce the costs of care after an initial course of therapy20.

6.3

6.4

6.5

6.6

PROBLEM STATEMENT

A study to determine the effectiveness of aromatherapy on back pain among the staff nurses in a selected hospital at Bangalore.

OBJECTIVES OF THE STUDY

1. 1. To assess the level of back pain among staff nurses.2. To determine the effectiveness of aromatherapy on back pain among the

staff nurses. 3. To associate the level of back pain among the staff nurses with their

selected demographic variables (age, sex, working experience, educational qualification, job title).

OPERATIONAL DEFINITIONS

Effectiveness:

The outcome of aromatherapy on back pain as determined by differences between pre and post pain scale score.

Aromatherapy:

It is a form of alternative medicine that uses essential oils in the warm bath and peppermint oil (essential oil) for the local application to alleviate back pain among staff nurses.

Back pain:

A subjective unpleasant experience by the staff nurses and which is assessed by visual analogue scale categorised as mild, moderate and severe back pain.

Staff nurses:

Registered qualified nursing personnel working in a selected hospital.

HYPOTHESIS

H1 There will be significant reduction on back pain among staff nurses after administration of aromatherapy. H2 There will be significant association between the level of back pain and their selected demographic variables.

6.7

6.8

6.9

6.10

7.

7.1

7.1.1

7.1.2

VARIABLES UNDER STUDY:

INDEPENDENT VARIABLE

In this study the independent variable is aromatherapy.

DEPENDENT VARIABLE

The dependent variable in the study is back pain among the staff nurses.

ASSUMPTION

Level of pain varies from individual to individual. The staff nurses who receive Aromatherapy will experience a reduction on

back pain. Aromatherapy improves the comfort of the staff nurses. Aromatherapy improves the quality nursing care.

DELIMITATION

The study will be delimited to staff nurses in a selected hospital.

The sample size is limited to only 30 subjects.

The study period is limited to 4weeks only.

PROJECTED OUTCOME

The study will reduce back pain among staff nurses.

MATERIALS AND METHODS

SOURCE OF DATA Registered staff nurses of selected hospital.

RESEARCH DESIGN

The research design will be quasi experimental design.

SETTING

The study will be conducted in a selected hospital, Bangalore. This hospital is run by a private management.

7.1.3

7.1.4

7.1.5

7.1.6

7.1.7

7.1.8

7.2

7.2.1

7.2.2

POPULATION

The study population comprises of staff nurses in a selected hospital.

SAMPLING PROCEDURE

SAMPLE SIZE

The sample size of this study will be 30, who are the staff nurses of selected hospital.

SAMPLING TECHNIQUE

The technique that is adopted for this study will be purposive sampling.

INCLUSION CRITERIA

a) Registered staff nurses of selected hospital. b) Those who cooperate during the study. c) both male and female staff nurses.

EXCLUSION CRITERIA

a) Staff nurses who are under other treatment for back pain. b) Staff nurses with back pain due to other disease conditions.c) Hypersensitive staff nurses (allergic to skin, olfactory).

INSTRUMENTS INTENDED TO BE USED

The instruments consist of two sections.

SECTION A: A tool to assess the information about demographic variables

SECTION B: A tool to assess the effectiveness of aroma therapy on back pain by visual analogue pain scale.

DATA COLLECTION METHOD

The samples will be selected from staff nurses based on the inclusion and exclusion criteria. Informed consent will be taken and the validated tool given as pre test to all participants. After pre-test, aromatherapy will be given followed by which post test scores will be measured.

DATA ANALYSIS PLAN It will be analysed through descriptive and inferential statistics. Statistical analysis such as standard deviation, percentage, mean, median, and mode will be used to

7.3

7.4

explain demographic variables. Paired‘t’ test will be used to determine effectiveness of aromatherapy. Chi-square analysis will be done to associate the pain and demographic variables

DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY.

Yes. The study requires implementation of aromatherapy to be provided among the staff nurses in a selected hospital at Bangalore.

HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?

1. Ethical clearance obtained from the research committee of Garden City College Of Nursing.

2. Permission will be obtained from the selected hospital in Bangalore.

3. consent will be taken from the registered staff nurses who are willing to participate in the study.

8.

REVIEW OF STYLE

1) http:// aromatherapy.savvy-cafe.com

2) Edris AE,(2007), pharmaceutical and therapeutic potentials of essential oils and their individual volatile constituents: a review, phytotherapy research, 21(4):308-323.

3) Tisserland, Robert(1977), The art of aromatherapy ISBN 0852071OX.

4) P.Ponnarasi(2008),effectiveness of aromatherapy on pain and its associated behavioural changes. Journal of Nightingale Nursing Times. Volume 4(6):42-43.

5) Seenivasan Prabuseenivasan, Manickkam Jayakumar et.al.,(2006). "In vitro antibacterial activity of some plant essential oils". BMC Complementary and Alternative Medicine 6 (39): 39-46.

6) Vander Watt G, Janca A.(2008), Aromatherapy in nursing and mental health care, Contemporary Nurse, 30 (1):69-75.

7) American pain society/ American college of physicians, Clinical Practice Guidelines, Annals of internal medicine, 147 :492-504.

8) http://www.nlm.nih.gov/medlineplus/backpain.html

9) http://www.ncbi.nlm.nih.gov/pubmed

10) Bekker AY (2006), evaluation of aromatherapy in treating postoperative pain, Journal of alternative and complementary medicine,13:247-251.

11) Marlene Ericksen (2000), Healing with Aromatherapy, McGraw-Hill Professional publishers, 9-11.

12) Shin, B.C., Lee, M.S. (2007), Effects of aromatherapy acupressure on hemiplegic shoulder pain and motor power in stroke patients, Journal of alternative and complementary medicine,13, 241-45.

13) Wilkinson, S., Aldridge, J., ey.al., (2007), An evaluation of aromatherapy massage in palliative care, Palliat Med, 3, 409-417.

14) Mitchinson, A.R., Kim, et.al.,(2006), Acute Postoperative Pain Management Using Massage as an Adjunctive Therapy: a Randomized Trial. Archives of Surgery, 142, 1158-1167.

15) Burnett, K.M., Solterbeck, L.A., et.al., (2004). Scent and mood state following an anxiety-provoking task. Psychological Reports, 95, 707-722.

16) Sayette, M.A. & Parrott, D.J. (1999), Effects of olfactory stimuli on urge reduction in smokers. Exp Clin Psychopharmacol, 7, 151-159.

17) Corinna Underwood (2008), The promise of aromatherapy. Essential oils have been shown in clinical trials to soothe some chronic ills brought on by old age:29(3):47-48.

18) Willem J.J Assendelft MD, PhD, et.al., (2007) Challenges in Systematic Reviews of complementary and mediine topics.105:529-536.

19) Chou, R., Huffman, L.H., American Pain Society, & American College of Physicians. (2007). Nonpharmacologic Therapies for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/ American College of Physicians Clinical Practice Guideline. Annals of Internal Medicine, 147, 492-504.

20) Daniel C Cherkin PhD,et.al., (2003), A review of the evidence for the effectiveness, safety, and cost of acupuncture, massagetherapy, and spinal manipulation for back pain,138:898-906.

SIGNATURE OF THE CANDIDATE

9.

10.

11.

12

12.1

12.2

12.3

12.4

13

13.1

REMARK OF THE GUIDE

PROF. SENTHIL KAVITHA

M.SC.(N) PhD

NAME AND DESIGNATION MEDICAL SURGICAL NURSING

OF THE GUIDE GARDEN CITY COLLEGE

BANGALORE

SIGNATURE

CO-GUIDE

SIGNATURE

PROF. SENTHIL. KAVITHAHEAD OF THE DEPARTMENT M.SC (N) PhD

SIGNATURE

REMARKS OF THE PRINCIPAL

SIGNATURE