Evidence based DNP project Title: Improving an Aromatherapy Program by Implementing an Evidence-based Clinical Guideline Using Empowered Holistic Nursing Education

Running head: IMPROVING AROMATHERAPY Improving an Aromatherapy Program by Implementing an Evidence-based Clinical Guideline Using Empowered Holistic Nursing Education

DNP Project Submitted in Partial Fulfillment Of the Requirements for the Degree of Doctor of Nursing Practice xxxxxx University xxxxx xxxxx June 2023 1 IMPROVING AROMATHERAPY Notice of Copyright Copyright All Rights Reserved 2 IMPROVING AROMATHERAPY Advisor Approval Page xxxxx UNIVERSITY xxxxxx This is to certify that I have examined this Doctor of Nursing Practice DNP project manuscript written by xxxxx and have found that it is complete and satisfactory in all respects, and that any and all revisions required by the final examining committee have been made. Graduate Programs Faculty _________________________________________________ Name of Faculty Project Advisor ________________________________________________ Date DEPARTMENT OF NURSING 3 IMPROVING AROMATHERAPY Abstract A home care agency provided a program for nurse delivered essential oil aromatherapy. Little documentation of the utilization of essential oils in client care was found two years after initial implementation. The aromatherapy program lacked clear guidance on how to apply the six stages of the home care nursing process. The Project Lead wrote an Evidence-Based Clinical Guideline for the home care agency Aromatherapy Program, including all six stages of the nursing process. Empowered Holistic Nurse Education theory guided the creation of nurse education materials to teach nurses to use the clinical guideline. Components of the nurse education theory were paired with the stages of rapid cycle quality improvement, Plan, Do, Study, Act. Improvement in the rate of documentation of the program indicated the project was successful with all participating homes achieving better than zero times of documentation per week and improved nurse scores on a Pre- and Post- Test of aromatherapy knowledge. Difficulties with implementation included lack of training time outside of regular duties and accessing online materials. A finding from the Pre- and Post-Implementation Surveys was an increase in nurses’ perceived authority to implement evidence-based practice change. Nurse education theory is useful for nurse leaders who want to promote changes in nursing practice. Teaching and learning circles of nurses in practice co-create quality improvements in patient care. Empowered nurses contribute practice-based evidence to evidence-based practice. Areas for further study include engaging nurses in the forty to sixty-year-old demographic and working with clients who have their own aromatherapy practices. Keywords: aromatherapy, clinical guideline development, Empowered Holistic Nurse Education, home care nursing, quality improvement, nurse leadership, nurse education, PDSA 4 IMPROVING AROMATHERAPY Improving an Aromatherapy Program by Implementing an Evidence-based Clinical Guideline Using Empowered Holistic Nursing Education . Families living with chronic complex care needs necessitating private duty home care nursing are economically disadvantaged, and therapeutic grade essential oils are costly and not covered by medical assistance (Rawlings & Meerabeau, 2003). A privately-owned home care agency (HCA) specializing in the care of ventilator dependent clients, initiated an aromatherapy program in 2016, to provide clients access to aromatherapy using essential oils at no cost to the client. All clients wanted to try using aromatherapy for symptom relief. Background This quality improvement project (QIP) was implemented in an HCA that provides 24-hour nursing care to ventilator (vent) dependent and other medically complex clients in their own homes. The QI Project Lead (PL) is the Director of Nursing at this HCA. The aromatherapy program is referred to as the MAP, an acronym representing the first initial of the agency name and aromatherapy program. Aromatherapy is the therapeutic use of plant essential oils. Problem description Responsible parties and clients of the HCA (n=7) were interviewed about their interest in using aromatherapy. Responsible parties are family or friends responsible for decision-making for the client. Every client or their responsible party expressed interest in using therapeutic aromatherapy in 2016. The PL conducted chart reviews in March and December of 2018 that revealed only five instances of documentation of aromatherapy for three of the clients between January 2016 and December 2018. Follow-up interviews and chart reviews provided limited evidence of clients receiving aromatherapy. All current clients are positively inclined toward using essential oils, but five families have little knowledge about their application and use. Two 5 IMPROVING AROMATHERAPY nurses (n=20) who currently work with clients for the HCA completed the initial two-hour training in 2016, no clients attended. Afterward, nurses had access to the information about the program for