A large percentage of the patient population served on Senior Behavioral Medicine Unit (SBMU) has a diagnosis of dementia. SBMU patients commonly present for treatment due to increased confusion, agitation, and aggression. In some patients, these behaviors further increase between 3-6 pm. This is known as sundowning. Sundowning leads to a more disruptive, stressful milieu for patients and staff alike. Several recent studies have reported beneficial reductions in agitated behavior with the utilization of aromatherapy. If the SBMU team can reduce or lessen the impact of the associated behaviors of dementia patients, then this will positively impact patient care, patient satisfaction, and staff satisfaction. The unit will also experience a less disruptive and stressful milieu for both patients and staff. This impact could, ultimately, have a positive effect on patient disposition, as well. Thus, allowing patient placement and discharge to occur in a shorter amount of time, reducing overall length of stay.
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A large percentage of the patient population served on Senior Behavioral Medicine Unit (SBMU) has a diagnosis of dementia. SBMU patients commonly present for treatment due to increased confusion, agitation, and aggression. In some patients, these behaviors further increase between 3-6 pm. This is known as sundowning. Sundowning leads to a more disruptive, stressful milieu for patients and staff alike. Several recent studies have reported beneficial reductions in agitated behavior with the utilization of aromatherapy. If the SBMU team can reduce or lessen the impact of the associated behaviors of dementia patients, then this will positively impact patient care, patient satisfaction, and staff satisfaction. The unit will also experience a less disruptive and stressful milieu for both patients and staff. This impact could, ultimately, have a positive effect on patient disposition, as well. Thus, allowing patient placement and discharge to occur in a shorter amount of time, reducing overall length of stay.
• Goal # 1: Statistically significant reduction in overall average behavior scale score (Maximum score = 16) for the patients, as a group, on aromatherapy day versus placebo day.
• Goal # 2: Total number of patients experiencing an improvement in the Pittsburg Agitation Scale score (PAS) on aromatherapy day versus placebo day.
• Goal # 3: Statistically significant reduction in the use of the total number of adjunct behavior interventions for the patients, as a group, on aromatherapy day versus placebo day.
• Goal # 4: Total number of patients requiring the use of adjunct behavior interventions will be reduced.
• Goal # 5: Statistically significant increase in the median number of sleep hours for the patients, as a group, on aromatherapy day versus placebo day.
• Lavender was diffused in the SBMU dining room and in front of the nurse’s station from 3-5pm, May 19, 2014 - May 28, 2014, alternating with placebo every other day.
• A nose plugged rater assessed the behavior of patients for one hour following the diffusion period, utilizing the PAS.
• In addition, the number of sleep hours and adjunct behavior interventions, such as PRN medications, merry walker utilization, and seclusion were noted during this timeframe.
• Data was analyzed to determine efficacy.
• Share the results with the SBMU nursing staff and physician.
• Engage an aromatherapy champion to serve as a change agent to lead the team in further utilization of the technique.
• Implement standardized, nightly utilization of lavender to enhance sleep for all SBMU patients.
• PAS score did not correlate with statistically significance data.
• Three PRN medications were utilized on placebo days, whereas no PRN medications were utilized on lavender days.
• The difference in sleep hours was statistically significant, very significant!
• Lavender promotes better sleep!
Holmes, C., et al. (2002). Lavender oil as a treatment for agitated behavior in severe dementia. International Journal of Geriatric Psychiatry, 17, 305-308.
Kelly St. Clair, BSN, RN &
Jennifer Williams, MSN, RN-BC
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