Procedure 66 CLINICAL PRIVILEGE WHITE PAPER Aromatherapy Background Aromatherapy is a holistic treatment that uses essential oils to achieve specific physical, emotional, mental, or spiritual effects. Essential oils are highly aromatic and concentrated liquids that are extracted from various parts of plants such as flowers, stems, leaves, woods, and resins. An essential oil derived from lavender, for example, is believed to be beneficial for dry skin and can help to relieve tension, headaches, and insomnia. Aromatherapy uses either inhalation or application techniques. For inhalation, a patient may take in the aroma of an essential oil from a handkerchief or a tissue or the aroma may be diffused throughout a room. When inhaled, micromolecules of essential oils travel through the nasal passages to the limbic system of the brain the seat of memory and emotion. This, in turn, may stimulate the entire body system, both emotionally and physically. For application, the essential oils are massaged onto the body and then permeate the skin. The oils are carried via the bloodstream throughout the body to strengthen and heal internal systems. The principal use of aromatherapy in a hospital setting is to relieve stress, so the therapy can be employed in various treatment areas. Aromatherapy is commonly used within psychiatric units, but the therapy can also be practiced in intensive care, pediatrics, orthopedics, neurology, and rehab. In England, nurses frequently use the therapy for obstetrics and postpartum care. Involved specialists Registered nurses, therapists, medical doctors, psychologists, chiropractors, acupuncturists, and cosmetologists. Positions of societies and academies NAHA The National Association for Holistic Aromatherapy (NAHA) publishes three levels of guidelines for aromatherapists. Level one: Basic family and self-care aromatherapist This level of study would be pursued by students wishing to care for themselves and their immediate family, sales and retail personnel, or by those desiring general basic use in selfcare and skin care. A supplement to Briefings on Credentialing 781/639-1872 Criteria reviewed 2006 1
Level two: Client-oriented aromatherapist Prerequisite: Satisfactory completion of level one This level of study suits those students desiring to treat individuals through consultation. Level three: Professional-oriented aromatherapist This level of study would be for professionals (teachers, nurses, doctors, naturopaths, chiropractors, and acupuncturists) who are seeking to add aromatherapy as an adjunct to their profession. Note: The NAHA states that the license allowing an aromatherapist to touch a client would have to be obtained through another discipline, such as massage therapist, nurse, esthetician, etc. The prerequisites for a level three aromatherapist are the satisfactory completion of levels one and two. The requirements for a level three aromatherapist are 250 hours in a two-year aromatherapy program, with six to eight teachers 30 case studies research papers and an eight-hour written and oral exam The curriculum requirements are anatomy and physiology review complete history of aromatherapy advanced botany/organic chemistry study of 20 carrier (vegetable) oils knowledge of 60 essential oils, including chemical properties, botanical and geographic origins, methods of extraction, all therapeutic properties, dangers and safety, and methods of application advanced consultation and blending techniques physiology of olfaction psychoneuroimmunology the mind/spirit/body connection with essential oils holistic medicine the interface of aromatherapy with massage, hypnotherapy, ayurvedic medicine, acupuncture, and psychology pathology nature of disease states advanced energetic work business and legal considerations distillation practical methods of extraction codes of ethical considerations 2 A supplement to Briefings on Credentialing 781/639-1872 Criteria reviewed 2006
It is also recommended that a specialty course of study, with a minimum of 100 hours, be included for level three aromatherapists. This specialty course would include the following topics: Aromatherapy and the medical profession Aromatherapy and herbalism Aromatherapy and acupuncture Aromatherapy and psychotherapy Internal uses, geriatrics, HIV/AIDS, animal/veterinary, terminal illness, sports medicine, ayurveda, energy work (touch for health), vibrational healing, psychological/ mental, women s care, and individual special interest projects The NAHA is currently in the process of devising standards for an aromatherapy certification program. In addition, the association plans to revise the above-outlined aromatherapy guidelines. PIA The Pacific Institute of Aromatherapy (PIA) offers a course in aromatherapy through organizations in Australia, Great Britain, and the United States. The course covers six aspects of aromatherapy. Part I provides substantial knowledge and a thorough analysis of essential oils. The topics addressed include production methods basics of distillation purity and adulteration quality grades of natural essential oils synthetic vs. natural definition of botanical origin chemical races Part II presents scientific research that supports holistic views and theories. Its main purpose is to present the most important categories of chemicals that are found in essential oils and their effects on the body. Part III is devoted to modern medical applications of essential oils and aromatic hydrosols. Students learn how French physicians successfully treat infections without antibiotics and that there are exact aromatherapy and phytotherapy prescriptions for upper and lower respiratory tract and gynecological conditions. Part IV covers cosmetology and regenerative skin care since A supplement to Briefings on Credentialing 781/639-1872 Criteria reviewed 2006 3
skin metabolism can be improved by the therapeutic use of essential oils. Part V explores the psychology of perfumery and the underlying erotic effect of fragrance materials. Part VI focuses on the safe use of essential oils and includes presentations of data gathered from published studies on the toxicology of essential oils. According to the PIA, students who successfully complete the institute s course will be able to use aromatherapy to treat many of their own symptoms and conditions strengthen their immune responses supply information on aromatherapy to others assess and judge the quality of essential oils design and produce state-of-the-art skin care preparations The PIA also offers an examination to students who have completed the aromatherapy course. Students who pass the exam receive certification in aromatherapy from the PIA. In regard to PIA certification, the institute states that, at this time, there are no certificates or licenses on a state level that would allow someone to practice aromatherapy under authority of that particular license. Aromatherapy can only be practiced within the particular discipline of the individual practitioner in question (such as a doctor, therapist, esthetician, etc.). Positions of other interested parties Aromatic Arts Education, Boulder, CO According to Laraine Kyle, RN, principal of the Boulder, CO based company, Aromatic Arts Education, and a founder of NAHA, aromatherapy is currently used in hospitals largely for palliative purposes and to give comfort. Particular uses include stress management, insomnia relief, skin care, and mood stabilization. Hospitals that are considering adding aromatherapy to its list of services would be well advised to hire a nurse or a massage therapist to do aromatherapy, Kyle says. These practitioners are professionals who are already licensed in their own fields to put their hands on patients, and they can use aromatherapy as an adjunct to their primary practice. A hospital should expect people to have at least 100 hours of 4 A supplement to Briefings on Credentialing 781/639-1872 Criteria reviewed 2006
training in aromatherapy and two years of supervised experience, Kyle says. In addition, the hospital should set up practice guidelines and standards as to how aromatherapy can be integrated into an overall treatment plan. The institution needs to be sure that there are boundaries of responsibility delineated, she continues, so that it is clear what the aromatherapist is expected to do and for what the sponsoring organization is responsible. CRC draft criteria When a hospital receives a request from a practitioner to use aromatherapy (or other holistic therapies like hypnotherapy or homeopathy) as an adjunct to his or her practice, it should not be the first time the hospital considers whether this type of therapy should be allowed to be used within the hospital. The policy covering aromatherapy (or other holistic therapies) should be drafted ahead of time by the board, resolving any liability, peer review, and reimbursement issues. In addition, the board should review federal and state laws, as well as state and local licensing requirements. The advice of the medical staff should be considered, along with the needs of the community, and the hospital s mission and strategic plan. Practitioners should have at least 100 hours of training in aromatherapy and two years of supervised experience, as well as licensure in the area in which the practitioner works. Other requirements should be tailored to the practitioner s particular institution. For more information For more information concerning aromatherapy, contact: National Association for Holistic Aromatherapy 838 Hanley Industrial Court St. Louis, MO 63144 Telephone: 314/963-2071 Fax: 314/963-4454 E-mail: info@naha.org Pacific Institute of Aromatherapy P.O. Box 6723 San Rafael, CA 94903 Telephone: 415/479-9121 Fax: 415/479-0119 A supplement to Briefings on Credentialing 781/639-1872 Criteria reviewed 2006 5
The information contained in this document is general. It has been designed and is intended for use by hospitals and their credentials committees in developing their own local approaches and policies for various credentialing issues. This information, including the materials, opinions, and draft criteria set forth herein, should not be adopted for use without careful consideration, discussion, additional research by physicians and counsel in local settings, and adaptation to local needs. The Credentialing Resource Center does not provide legal or clinical advice; for such advice, the counsel of competent individuals in these fields must be obtained. Reproduction in any form outside the recipient s institution is forbidden without prior written permission. Copyright 1998 Opus Communications, Marblehead, MA 01945. 6 A supplement to Briefings on Credentialing 781/639-1872 Criteria reviewed 2006