addition,determining the purity of the oil and how REFERENCES 1.Dogan O,Ertekin S,Dogan S.Sleep quality in hospital- much a patient actually sensed or perceived the ized patients.J Clin Nurs.2005;14(1):107-113. aroma is difficult and could introduce intervention 2.Patel M,Chipman J,Carlin BW,Shade D.Sleep in the bias.Despite these challenges,patients in the treat- intensive care unit setting.Crit Care Nurs Q.2008;31 (4:309-318. ment group had higher sleep scores than did the 3.Spiegel K,Sheridan JF,Van Cauter E.Effect of sleep deprivation on response to immunization.JAMA.2002; control group for most questions,suggesting that 288(12:1471-1472. lavender aromatherapy may be a promising inter- 4.Hellstrom A,Fagerstrom C,Wilman A.Promoting sleep by nursing interventions in health care settings:a sys- vention to enhance perceived sleep.On the basis tematic review.Worldviews Evid Based Nurs.2011;8(3): of our results,we suggest that future studies be con 128=142. ducted in larger numbers of patients,with a pretest- 5.Buckle J.Literature review:should nursing take aro matherapy more seriously?Br J Nurs.2007;16(2):116-120. posttest design and use of methods to reduce bias. 6.Dunn C,Sleep J,Collett D.Sensing an improvement: Because of the adverse effect of poor sleep quality an experimental study to evaluate the use of aromather- apy,massage,and periods of rest in an intensive care in critically ill patients,research on ways to improve unit.JAdv Nurs.1995;21:34-40. 7.Soden K,Vincent K,Craske S,Lucas C,Ashley S.A sleep in acute care settings should continue. randomized controlled trial of aromatherapy massage in a hospice setting.Palliat Med.2004;18(2):87-92. Conclusion 8.Van der Watt G,Janca A.Aromatherapy in nursing and mental health care.Contemp Nurse.2008;30(1):69-75. Despite limitations,the results of our pilot 9.Van Cauter E,Spiegel K,Tasali E,Leproult R.Metabolic study on alternative therapy to enhance sleep have consequences of sleep and sleep loss.Sleep Med. 2008:9(suppl1):S23-S28. important implications.Sleep is essential to healing, 10.Lewith GT,Godfrey AD,Prescott P.A single-blinded, and finding ways to offer patients more restful sleep randomized pilot study evaluating the aroma of Lavan- dula augustifolia as a treatment for mild insomnia.J while they are hospitalized is critical,particularly in Altern Complement Med.2005;11(4):631-637. 11. more acute care settings such as the IMCU.We Penzel T,Kantelhardt J,Lo C,Voigt K,Vogelmeier C. Dynamics of heart rate and sleep stages in normals detected a decrease in blood pressure after the 6 hours and patients with sleep apnea.Neuropsychopharma- of treatment and higher satisfaction with sleep after cology.2003:28(suppl 1):S48-S53. 12.Richards KC,O'Sullivan PS,Phillips RL Measu rement the use of lavender aromatherapy.We think that of sleep in critically ill patients.J Nurs Meas.2000:8(2): 131.144 conducting a randomized controlled trial of aro- 13.Halm M.Essential oils for management of symptoms matherapy in an IMCU is feasible.Research using in critically ill patients.Am J Crit Care.2008;17;160-163 larger numbers of patients is required to understand 14.Chien LW,Cheng SL,Liu FC.The effects of lavender aromatherapy on autonomic nervous system in midlife the effects of lavender aromatherapy on sleep in the women with insomnia.Evid Based Complementary Altern Med.2012:2012:740813. hospital and whether a combination of alternative 15. Moeini M,Khadibi M,Bekhradi R,Mahmoudian SA therapies,such as massage or music,would have Nazari F.Effect of aromatherapy on the quality of sleep greater effects than aromatherapy alone. in ischemic heart disease patients hospitalized in inten- sive care units of heart hospitals of the Isfahan University of Medical Sciences.Iran J Nurs Midwifery Res.2010; ACKNOWLEDGMENTS 15(4:234-239. We acknowledge Maddy Biggs,Kathy Wagner-Kosmakos 16.Cooke B,Ernst E.Aromatherapy:a systematic review. and the nurses on the medical progressive care unit. Br J Gen Pract..2000:50(455:493-496. 17.Louis M.Kowalski SD.Use of aromatherapy with hospice FINANCIAL DISCLOSURES patients to decrease pain,anxiety,and depression and This work was supported through the Crickett Julius to promote an increased sense of well-being.Am J Hosp Palliat Care.2002;19(6):381-386. Memorial Scholarship Fund. eLetters To purchase electronic or print reprints,contact the Now that you've read the article,create or contribute to an American Association of Critical-Care Nurses,101 online discussion on this topic.Visit www.ajcconline.org Columbia,Aliso Viejo,CA 92656.Phone,(800)899-1712 and click "Responses"in the second column of either the full-text or PDF view of the article. or(949)362-2050(ext532:fax,(949)362-2049:e-mail, reprints@aacn.org. www.ajcconline.org AJCC AMERICAN JOURNAL OF CRITICAL CARE,January 2014,Volume 23,No.1 29 Downloaded from ajcc.aacnjournals.org by guest on April 27,2015addition, determining the purity of the oil and how much a patient actually sensed or perceived the aroma is difficult and could introduce intervention bias. Despite these challenges, patients in the treat￾ment group had higher sleep scores than did the control group for most questions, suggesting that lavender aromatherapy may be a promising inter￾vention to enhance perceived sleep. On the basis of our results, we suggest that future studies be con￾ducted in larger numbers of patients, with a pretest￾posttest design and use of methods to reduce bias. Because of the adverse effect of poor sleep quality in critically ill patients, research on ways to improve sleep in acute care settings should continue. Conclusion Despite limitations, the results of our pilot study on alternative therapy to enhance sleep have important implications. Sleep is essential to healing, and finding ways to offer patients more restful sleep while they are hospitalized is critical, particularly in more acute care settings such as the IMCU. We detected a decrease in blood pressure after the 6 hours of treatment and higher satisfaction with sleep after the use of lavender aromatherapy. We think that conducting a randomized controlled trial of aro￾matherapy in an IMCU is feasible. Research using larger numbers of patients is required to understand the effects of lavender aromatherapy on sleep in the hospital and whether a combination of alternative therapies, such as massage or music, would have greater effects than aromatherapy alone. ACKNOWLEDGMENTS We acknowledge Maddy Biggs, Kathy Wagner-Kosmakos, and the nurses on the medical progressive care unit. FINANCIAL DISCLOSURES This work was supported through the Crickett Julius Memorial Scholarship Fund. REFERENCES 1. Dogan O, Ertekin S, Dogan S. Sleep quality in hospital￾ized patients. J Clin Nurs. 2005;14(1):107-113. 2. Patel M, Chipman J, Carlin BW, Shade D. Sleep in the intensive care unit setting. Crit Care Nurs Q. 2008;31 (4):309-318. 3. Spiegel K, Sheridan JF, Van Cauter E. Effect of sleep deprivation on response to immunization. JAMA. 2002; 288(12):1471-1472. 4. Hellstrom A, Fagerström C, Wilman A. Promoting sleep by nursing interventions in health care settings: a sys￾tematic review. Worldviews Evid Based Nurs. 2011;8(3): 128-142. 5. Buckle J. Literature review: should nursing take aro￾matherapy more seriously? Br J Nurs. 2007;16(2):116-120. 6. Dunn C, Sleep J, Collett D. Sensing an improvement: an experimental study to evaluate the use of aromather￾apy, massage, and periods of rest in an intensive care unit. J Adv Nurs. 1995;21:34-40. 7. Soden K, Vincent K, Craske S, Lucas C, Ashley S. A randomized controlled trial of aromatherapy massage in a hospice setting. Palliat Med. 2004;18(2):87-92. 8. Van der Watt G, Janca A. Aromatherapy in nursing and mental health care. Contemp Nurse. 2008;30(1):69-75. 9. Van Cauter E, Spiegel K, Tasali E, Leproult R. Metabolic consequences of sleep and sleep loss. Sleep Med. 2008;9(suppl 1):S23-S28. 10. Lewith GT, Godfrey AD, Prescott P. A single-blinded, randomized pilot study evaluating the aroma of Lavan￾dula augustifolia as a treatment for mild insomnia. J Altern Complement Med. 2005;11(4):631-637. 11. Penzel T, Kantelhardt J, Lo C, Voigt K, Vogelmeier C. Dynamics of heart rate and sleep stages in normals and patients with sleep apnea. Neuropsychopharma￾cology. 2003;28(suppl 1):S48-S53. 12. Richards KC, O’Sullivan PS, Phillips RL. Measurement of sleep in critically ill patients. J Nurs Meas. 2000;8(2): 131-144. 13. Halm M. Essential oils for management of symptoms in critically ill patients. Am J Crit Care. 2008;17;160-163. 14. Chien LW, Cheng SL, Liu FC. The effects of lavender aromatherapy on autonomic nervous system in midlife women with insomnia. Evid Based Complementary Altern Med. 2012;2012:740813. 15. Moeini M, Khadibi M, Bekhradi R, Mahmoudian SA, Nazari F. Effect of aromatherapy on the quality of sleep in ischemic heart disease patients hospitalized in inten￾sive care units of heart hospitals of the Isfahan University of Medical Sciences. Iran J Nurs Midwifery Res. 2010; 15(4):234-239. 16. Cooke B, Ernst E. Aromatherapy: a systematic review. Br J Gen Pract. 2000;50(455):493-496. 17. Louis M, Kowalski SD. Use of aromatherapy with hospice patients to decrease pain, anxiety, and depression and to promote an increased sense of well-being. Am J Hosp Palliat Care. 2002;19(6):381-386. To purchase electronic or print reprints, contact the American Association of Critical-Care Nurses, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 899-1712 or (949) 362-2050 (ext 532); fax, (949) 362-2049; e-mail, reprints@aacn.org. eLetters Now that you’ve read the article, create or contribute to an online discussion on this topic. Visit www.ajcconline.org and click “Responses” in the second column of either the full-text or PDF view of the article. www.ajcconline.org AJCC AMERICAN JOURNAL OF CRITICAL CARE, January 2014, Volume 23, No. 1 29 Downloaded from ajcc.aacnjournals.org by guest on April 27, 2015