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5/6/2023

CURRENT STATE GAP FUTURE STATE

Emergency Department Staff currently undergo high levels of stress and decreased energy levels due to high patient acuity, overcrowding, boarding inpatients and Post Traumatic Stress.

A healthier environment with increased energy and

decreased stress. With continued promotion of wellness and positive

energy in a holistic way that enriches those staff

members in our department.

Due to multiple patient conditions the department frequently experiences foul odors.

Minimized and decreased foul odors within the department through diffusion of therapeutic essential oils.

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STRENGTHS WEAKNESSES

High level of staff interest to enhance the environment and promote wellnessIncrease Energy Decrease StressEliminate Foul OdorsPromotes Further EducationSupports Vanderbilt’s Mission StatementShows our ongoing commitment and dedication to our staffIncreases Staff WellnessSupported by Evidenced Based PracticeImproves air quality by decreasing airborne pathogensAdvantage of using Certified Pure Therapeutic Grade Essential Oils No synthetic/perfume additives Unlikely risk of adverse effects

Lack of Education and UnderstandingChange of Mindset

OPPORTUNITIES THREATS

Pilot Wellness initiative study with measurable outcomes.Furthering EducationDevelopment of a Wellness Model that can be used by other departmentsFortifying relationshipsDeveloping Leadership for staff promotionStaff RetentionCreates a more appealing place to work

Closed MindednessResistance to ChangeLack of Education and Understanding

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Evidence Based Practice

Many hospitals are now incorporating the use of Essential Oils. For example, Harris Methodist Fort Worth Hospital uses 33 different Therapeutic Grade Essential Oils that are dispensed by their pharmacy. Studies show they relieve stress and anxiety for patients and staff, findings also show they can reduce pain and facilitate sleep for the patient.

HOSPITALS AND OTHER INSTITUTIONS EMPLOYING ESSENTIAL OILS: A SAMPLING

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Desert Samaritan Medical Center – Mesa, ArizonaFountain Valley Hospital – Fountain Valley, CaliforniaOrange Coast Memorial Hospital – Fountain Valley, CaliforniaSaddleback Medical Center – Laguna Hills, CaliforniaMidway Hospital – Los Angeles, CaliforniaChildren’s Hospital and Health Center – San Diego, CaliforniaSan Diego Hospice – San Diego, CaliforniaCalifornia Pacific Medical Center – San Francisco, CaliforniaO’Connor Hospital – San Jose, CaliforniaAspen Valley Hospital – Aspen, ColoradoMemorial Hospital – Colorado Springs, ColoradoSt. Anthony Hospitals, Centura Health – Englewood, ColoradoGunnison Valley Hospital – Gunnison, ColoradoGriffin Hospital – Derby, ConnecticutSt. Francis Medical Center – Hartford, ConnecticutWindham Community Memorial Hospital – Willimantic, ConnecticutHoly Cross Hospital – Sunrise, FloridaNorthside Hospital – Atlanta, GeorgiaNorth Hawaii Community Hospital – Kameula, HawaiiAdvocate Good Shepherd Hospital – Barrington, IllinoisSt. James Health and Wellness Institute – Chicago, IllinoisAdvocate Healthcare – Oakbrook, IllinoisDeaconess Hospital – Evansville, IndianaRiverview Hospital – Noblesville, IndianaMemorial Health System – South Bend, IndianaCharlton Health System – Fall River, MassachusettsSt. Luke’s Health Care System – New Bedford, MassachusettsMorton Hospital and Medical Center – Taunton, MassachusettsTobey Health Systems – Wareham, MassachusettsBarbara Ann Karmanos Cancer Institute – Detroit, MichiganBronson Methodist Hospital – Kalamazoo, MichiganMercy Hospital Group – Port Huron, MichiganSt. John’s Health – Warren, Michigan

Children’s Hospital – St. Paul, MinnesotaRegions Hospital – St. Paul, MinnesotaSt. Peter Community Hospital – St. Paul, MinnesotaWoodwinds Health Campus – Woodbury, MinnesotaBarnes-Jewish Hospital – St. Louis, MissouriSt. Luke’s Hospital – Chesterfield, MissouriBergen Mercy Medical Center – Omaha, NebraskaSt. Rose Dominican Hospital – Henderson, NevadaWentworth-Douglas Hospital – Dover, New HampshireCooper Hospital/University Medical Center-Camden, New Jersey

St. Barnabas Health Care System – Hackensack, New JerseyMountainside Medical Center – Montclair, New JerseyBellevue Women’s Hospital – Albany, New YorkSt. Peter’s Medical Center – Albany, New YorkNorthern Westchester Hospital Center-Mount Kisco, New YorkColumbia Presbyterian Medical Center – New York, New YorkMorgan Stanley Children’s Hospital – New York, New YorkNew York-Weill Cornell Children’s Hospital-New York, New YorkHugh Chatham Memorial Hospital – Elkin, North CarolinaIredell Memorial Hospital – Statesville, North CarolinaChildren’s Hospital Medical Center – Akron, OhioHighline Community Hospital – Burien, WashingtonElmbrook Memorial Hospital – Brookfield, WisconsinAlliance Community Hospital – Alliance, OhioCleveland Clinic Health System – Chagrin Falls, OhioUHHS Bainbridge Health Center – Chagrin Falls, OhioUniversity Hospitals’ Health System – Cleveland, OhioMercy Health Center – Oklahoma City, OklahomaHarris Methodist Fort Worth Hospital-Fort Worth, TexasSt. Charles Medical Center – Bend, OregonMid-Columbia Medical Center – The Dalles, OregonElk Regional Health Center – Elk, PennsylvaniaSt. Peter’s Hospital – Jeanette, PennsylvaniaWindber Medical Center – Windber, Pennsylvania

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References

Carson, C.F., Hammer, K.A., and T.V. Riley. “Melaleuca alternifolia (tea tree) oil: A review of antimicrobial and other medicinal properties.” Clinical Microbiology Reviews 19, (2006): 50-62.

Faoagali, J., George, N., and J.F. Leditschke. “Does tea tree oil have a place in the topical treatment of burns.” Burns 4, (1997): 349-51.

Carson, C.F., Cookson, B.D. et al. “Susceptibility of methicillin-resistant staphylococcus-aureus to the essential oil of melaleuca-alternifolia.”Journal of Antimicrobial Chemotherapy 35, (1995): 421-4.

Klevens, R.M., Morrison, M.A., et al. “Invasive methicillin-resistant staphylococcus aureus infections in the United States.” Journal of the American Medical Association 298, (2007): 1763-71.

Warnke, P.H., Becker, S.T., et al. “The battle against multi-resistant strains: Renaissance of antimicrobial essential oils as a promising force to fight hospital-acquired infections.” Journal of Craniomaxillofacial Surgery, May 25, 2009.

Caelli, M., Porteous, J., et al. “Tea tree oil as an alternative topical decolonization agent for methicillin-resistant staphylococcus aureus.” Journal of Hospital Infection 46, (2000): 236-7.

Lehrner, J., Marwinski, G., et al. “Ambient odors of orange and lavender reduce anxiety and improve mood in a dental office.” Physiology and Behavior 86, (2005): 92-5.

Field, T., Field, T., et al. “Lavender bath oil reduces stress and crying and enhances sleep in very young infants.” Early Human Development 84, (2008): 399-401.

Spirling, L.I., and I.R. Daniels. “Botanical perspectives on health peppermint: more than just an after-dinner mint.” The Journal of the Royal Society for the Promotion of Health 121, (2001): 62-3.

Kite, S., Maher, E., et al. “Development of an aromatherapy service at a cancer centre.” Palliative Medicine 12, (1998): 171-80.

Maddocks-Jennings, W., and Jenny M. Wilkinson. “Aromatherapy practice in nursing: literature review.” Journal of Advanced Nursing 48, (2004): 93-103.

Baratta, M.T., Dorman, H.J., Stanley, G.D., et al. “Antimicrobial and antioxidant properties of some commercial essential oils.” Flavour and Fragrance Journal 13 (1998): 235-44. Nakamura, A., Fujiwara, S., Matsumoto, I., et al. “Stress repression in restrained rats by (R)-(-)-Linalool inhalation and gene expression profiling of their whole blood cells.” Journal of Agricultural and Food Chemistry 57, no 12 (2009): 5480-85. Warnke, P.H., Sherry, E., et al. “Antibacterial essential oils in malodorous cancer patients: clinical observations in 30

patients.” Phytomedicine 13, (2006): 463-7. Eccles, R., Griffiths, D.H., et al. “The effects of D and L isomers of menthol upon nasal sensation of airflow.” The Journal

of Laryngology and Otology 102, (1988): 506-8. Warnke, P.H., Becker, S.T., et al. “The battle against multi-resistant strains: Renaissance of antimicrobial essential oils as

a promising force to fight hospital-acquired infections.” Journal of Cranio-Maxillofacial Surgery 37, (2009): 392-7. Brady, A., Loughlin, R., et al. “In Vitro activity of tea-tree oil against clinical skin isolates of methicillin-resistant and

sensitive Staphylococcus aureus and coagulase-negative staphylococci growing planktonically and as biofilms.” Journal of Medical Microbiology 55, (2006): 1375-80.

Caelli, M., Porteous, J., et al. “Tea tree oil as an alternative topical decolonization agent for methicillin-resistant Staphylococcus aureus.” Journal of Hospital Infection 46, (2000): 236-7.

Groves, Bob. “Healing’s Sweet Scent.” The Record August 1, 2006. Edwards-Jones, V., Buck, R., et al. “The effect of essential oils on methicillin-resistant Staphylococcus aureus using a

dressing model.” Burns 30, (2004): 772-7. Warnke, P.H., Sherry, E., et al. “Antibacterial essential oils in malodorous cancer patients: Clinical observations in 30

patients.” Phytomedicine 13, (2006): 463-7. Bagg, J., Jackson, M.S., et al. “Susceptibility to Melaleuca alternifolia (tea tree) oil of yeasts isolated from the mouths of

patients with advanced cancer.” Oral Oncology 42, (2006): 487-92. Hammer, K.A., Carson, C.F., et al. “Antimicrobial activity of essential oils and other plant extracts.” Journal of Applied

Microbiology 86, (1999): 985-90. Kivanc, M. and A. Akgul. “Antibacterial activities of essential oils from Turkish spices and citrus.” Flavour and Fragrance

Journal 1, (2006): 175-9. Wheeler, Jo L., “The Science and Art of Aromatherapy.” Journal of Holistic Nursing 17;5 (1999).

Vanderbilt Wellness Committee

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Essential Oil Protocol

Identify metrics for evaluation:

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All Staff working within the Emergency Department will be able to seek a member of the

wellness committee to access the therapeutic essential oils for use.

TOPICALINGESTION

Direct Application, Reflex Therapy and AromaTouch

Therapy with Essential Oils available for multiple uses.

GRAS (Generally recognized as safe for human

consumption) Essential Oils available for multiple uses.

DIFFUSION

Essential Oils will be diffused throughout the department.

Air Freshening Protocol will be initiated for foul odors.

Wellness Committee Essential Oils Usage Guidelines

1. Essential Oils will be available for staff use only. They are not for patient use.

2. Members of the Wellness Committee will access the Essential Oils for employee use.

3. Staff participation is voluntary.4. Essential Oils are provided for use in the workplace, not for

employees to take home.5. Essential Oils are donated to the Emergency Department, they are

not for purchase.6. There will be an air freshening protocol when there is a foul odor.

-Enhance the workplace environment.

-Increase energy.

-Decrease Stress.

-Decrease foul odors in the department.

Identify who needs education on initiative: Wellness Champions

Wellness Committee members

Staff

Physicians

Assign accountability and clear timeline:

Action Person Assigned Timeline Status

Initial Meeting with Brent Lemonds, Administrative Director, Emergency Services

Tonya McBride, Teresa Sturges

April 15, 2010 Completed

Meet with Dr. Ian Jones, Medical Director, Adult Emergency Services


April 15, 2010 Completed

Meeting with Dr. David Hill, Chief Medical Advisor, Chairman; Scientific Advisory Committee-doTerra International, Dr. Ian Jones and Brent Lemonds

Tonya McBride, Teresa Sturges, Candise Hillman, Ali Grubbs, Dawn Hawley, Ruthie Curbow.

May 11, 2010 Completed

Initial Wellness Committee Meeting

Tonya McBride, Teresa Sturges, Candise Hillman, Ali Grubbs, Ruthie Curbow. Dr. David Hill


Meet with Janice Sisco, Manager Adult Emergency

Tonya McBride, Teresa May 13, 2010 Completed

5/6/2023


Department Sturges

Identify and Recruit Committee Members and Super-users

Tonya McBride, Teresa Sturges, Dawn Hawley, Candise Hillman, Ali Grubbs


Electronic communication to update the Wellness Committee members concerning current progress and rollout timeline



Development of Wellness Committee mission statement, Standard Rollout Process and SWOT Analysis

Tonya McBride, Teresa Sturges, Candise Hillman, Ali Grubbs, Morgan Vero, Lauren McCartney, Diana Alward, Ruthie Curbow.


Draft of The Standard Rollout document

Tonya McBride, Ali Grubbs


Development of PowerPoint Presentation introducing The Wellness Committee



Unit Board Presentation Ali Grubbs May 25, 2010 Completed

Potty News Flyers Teresa Sturges, Tonya McBride


Secure location for monthly Wellness Committee meeting

Tonya McBride, Alma Catlin


Introduction of Wellness Committee through Friday Communication

Janice Sisco May 28, 2010 Completed

5/6/2023


Completion of Final Draft of The Standard Rollout Document.

Tonya McBride, Teresa Sturges, Candise Hillman, Ali Grubbs

June 3, 2010 Completed

Education of basic Essential Oil Use to all Wellness Committee members


June 4, 2010 Pending

Electronic Communication to all staff introducing The Wellness Committee with PowerPoint Presentation attachment

Tonya McBride June 4, 2010 Pending

Begin data collection, surveying staff for a period of 2 weeks prior to going live, to establish measurable outcomes

Survey Task Force June 7, 2010 Pending

Go live with essential oil usage/diffusion

Wellness Committee Members

June 21, 2010 Pending

Feature Wellness Committee in ED Newsletter

Diana Alward June 30, 2010 Pending

Continue data collection with post survey, to establish measurable outcomes

Survey Task Force July 31, 2010 Pending

Debrief and adjust action plan

Wellness Committee Members

July 23, 2010 Pending

5/6/2023

Development for Sustained SuccessMonthly Wellness Committee meetings that will include educational training. Establish Wellness Committee guidelines for proper use of Essential Oils.Pilot Wellness initiative study with measurable outcomes to structure a beneficial wellness program.Monthly educational updates for staff. Committee Members will be available as a resource to staff.An Essential Oil Formulary will be readily available in the department.Debrief and adjust action plan based on measured outcomes.

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Identify Methods of Content Delivery: See figure 1 for summary.

Change Theory:

Stetler Model Theory-

This theory integrates Evidenced Based Practice with research.

There are five phases: 1) Preparation

2) Validation

3) Comparative evaluation and decision making

4) Translation and Application

5) Evaluation

http://74.6.239.67/search/cache?ei=UTF-8&p=Stetler+Model+Theory&fr=yfp-t-152&u=courseweb.edteched.uottawa.ca/nsg6133/Course_Modules/Module_PDFs/Stetler-Marram.pdf&w=stetler+model+theory+theories&d=DwzyEd29TeE2&icp=1&.intl=us&sig=gArTsgbpYybXu1qZMKbNfw--

Knowledge Translation

-provides a framework that may be helpful in considering the challenges that clinicians are likely to face when attempting to implement evidence based practice.

- exchange, synthesis, and ethically sound application of knowledge within a complex system of interactions among researchers and users to accelerate capture of the benefits of research.

Rogers Diffusion of Innovations-

-Behavioral theory that describes the process the user goes through in the adaptation/rejection of new ideas, practices, and technology.

5/6/2023

DIFFUSION




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