204. Aromatherapy For Postoperative Vomiting

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204. Aromatherapy For Postoperative Vomiting

 

 

CATEGORY:Alternative Medicines 300 Courses

COURSE NUMBER: 204

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Syllabus

Keywords……………………………………………………………………………………………………………………………….ii
Abstract……………………………………………………………………………………………………………………………….. iii
Table of Contents………………………………………………………………………………………………………………….. iv
List of Figures………………………………………………………………………………………………………………………… x
List of Tables ………………………………………………………………………………………………………………………… xi
List of Abbreviations …………………………………………………………………………………………………………….. xii
Publications Arising from this Work……………………………………………………………………………………….. xiii
Statement of Original Authorship………………………………………………………………………………………….. xiv
Acknowledgements………………………………………………………………………………………………………………. xv
CHAPTER 1: INTRODUCTION …………………………………………………………………………… 1
1.1 BACKGROUND………………………………………………………………………………………………………………1
1.1.1 Postoperative Nausea and Vomiting ……………………………………………………………………..1
1.1.2 Current Treatment for Postoperative Nausea and Vomiting …………………………………….1
1.1.3 Aromatherapy ……………………………………………………………………………………………………2
1.1.4 Aromatherapy for Postoperative Nausea and Vomiting …………………………………………..3
1.2 Context ……………………………………………………………………………………………………………………….4
1.3 Purposes ……………………………………………………………………………………………………………………..4
1.3.1 Aims and Objectives……………………………………………………………………………………………4
1.3.2 Research Questions…………………………………………………………………………………………….5
1.4 Significance, Scope and Definitions…………………………………………………………………………………5
1.4.1 Significance………………………………………………………………………………………………………..5
1.4.2 Scope ………………………………………………………………………………………………………………..5
1.4.3 Definitions …………………………………………………………………………………………………………6
1.5 Thesis Outline ………………………………………………………………………………………………………………7
CHAPTER 2: LITERATURE REVIEW…………………………………………………………………. 9
2.1 Risk Factors for Postoperative Nausea and Vomiting…………………………………………………………9

2.2 The Study of Postoperative Nausea and Vomiting …………………………………………………………..11
2.3 Prevention and Treatment of Postoperative Nausea and Vomiting……………………………………12
2.4 Aromatherapy: Mechanism of Action…………………………………………………………………………….14
2.5 Aromatherapy for Postoperative Nausea and Vomiting……………………………………………………16
2.5.1 Ginger Versus Placebo for Prevention of PONV …………………………………………………….17
2.5.2 Ginger versus Pharmacological Antiemetics for Prevention of PONV……………………….17
2.6 Systematic Reviews of Ginger for Prevention of PONV …………………………………………………….18
2.6.1 Essential Oil Mixtures to Prevent and Treat PONV…………………………………………………20
2.6.2 Peppermint Oil for the Treatment of PONV ………………………………………………………….21
2.6.3 Isopropyl Alcohol to Treat Postoperative Nausea and Vomiting………………………………22
2.7 Use of Aromatherapy…………………………………………………………………………………………………..26
2.8 Nursing Use of Aromatherapy in Clinical Practice ……………………………………………………………27
2.9 Use of Evidence in Practice…………………………………………………………………………………………..30
2.10 Summary and Implications …………………………………………………………………………………………..31
CHAPTER 3: METHODS …………………………………………………………………………………….. 33
3.1 Setting……………………………………………………………………………………………………………………….33
3.2 Methodology and Research Design ……………………………………………………………………………….34
3.3 Delphi Process…………………………………………………………………………………………………………….34
3.3.1 Methodology ……………………………………………………………………………………………………34
3.3.2 Research Design………………………………………………………………………………………………..35
3.3.3 Participants………………………………………………………………………………………………………36
3.3.4 Instruments ……………………………………………………………………………………………………..37
3.3.5 Analysis……………………………………………………………………………………………………………37
3.4 Survey ……………………………………………………………………………………………………………………….38
3.4.1 Survey Methodology………………………………………………………………………………………….38
3.4.2 Research Design………………………………………………………………………………………………..38
3.4.3 Participants………………………………………………………………………………………………………38
3.4.4 Instruments ……………………………………………………………………………………………………..39
3.4.5 Data Analysis…………………………………………………………………………………………………….40

3.5 Ethics and Limitations for Delphi Process and Survey ………………………………………………………40
3.6 Workplace Health and Safety ……………………………………………………………………………………….41
CHAPTER 4: SYSTEMATIC REVIEW……………………………………………………………….. 43
4.1 Background………………………………………………………………………………………………………………..43
4.1.1 Aromatherapy and Postoperative Nausea and Vomiting………………………………………..43
4.1.2 Cochrane Review Methodology ………………………………………………………………………….46
4.2 Objectives………………………………………………………………………………………………………………….47
4.3 Methods…………………………………………………………………………………………………………………….48
4.3.1 Criteria for Considering Studies for This Review ……………………………………………………48
4.4 Search Methods for Identification of Studies………………………………………………………………….49
4.4.1 Electronic Searches……………………………………………………………………………………………49
4.4.2 Searching Other Resources…………………………………………………………………………………49
4.5 Data Collection and Analysis…………………………………………………………………………………………50
4.5.1 Selection of Studies…………………………………………………………………………………………..50
4.5.2 Data Extraction and Management……………………………………………………………………….50
4.5.3 Assessment of Risk of Bias in Included Studies ……………………………………………………..50
4.5.4 Measures of Treatment Effect…………………………………………………………………………….50
4.5.5 Unit of Analysis Issues……………………………………………………………………………………….51
4.5.6 Dealing with Missing Data ………………………………………………………………………………….51
4.5.7 Assessment of Heterogeneity……………………………………………………………………………..51
4.5.8 Assessment of Reporting Biases………………………………………………………………………….51
4.5.9 Data Synthesis………………………………………………………………………………………………….51
4.5.10 Subgroup Analysis and Investigation of Heterogeneity…………………………………………..52
4.5.11 Sensitivity Analysis…………………………………………………………………………………………….52
4.6 Results……………………………………………………………………………………………………………………….52
4.6.1 Description of Studies………………………………………………………………………………………..52
4.6.2 Results of the Search …………………………………………………………………………………………52
4.6.3 Included Studies ……………………………………………………………………………………………….54
4.6.4 Excluded Studies……………………………………………………………………………………………….54

Aromatherapy for postoperative nausea and vomiting vii
4.7 Risk of Bias in included Studies……………………………………………………………………………………..54
4.7.1 Allocation (selection bias)…………………………………………………………………………………..55
4.7.2 Blinding (performance bias and detection bias)…………………………………………………….56
4.7.3 Incomplete Outcome Data (attrition bias) ……………………………………………………………56
4.7.4 Selective Reporting (reporting bias)…………………………………………………………………….56
4.7.5 Other Potential Sources of Bias…………………………………………………………………………..56
4.8 Effects of Interventions………………………………………………………………………………………………..57
4.8.1 Primary Outcome: Severity and Duration of Nausea ……………………………………………..57
4.8.2 Primary Outcome: Duration of Nausea ………………………………………………………………..58
4.8.3 Primary Outcome: Severity of Nausea………………………………………………………………….59
4.8.4 Secondary Outcome: Use of Rescue Antiemetics…………………………………………………..59
4.8.5 Secondary Outcome: Adverse Reactions………………………………………………………………64
4.8.6 Secondary Outcome: Patient Satisfaction with Treatment……………………………………..64
4.9 Discussion ………………………………………………………………………………………………………………….66
4.9.1 Summary of Main Results…………………………………………………………………………………..66
4.9.2 Overall Completeness and Applicability of Evidence………………………………………………67
4.9.3 Quality of the Evidence………………………………………………………………………………………67
4.9.4 Agreements and Disagreements with Other Studies or Reviews……………………………..68
4.10 Authors’ Conclusions …………………………………………………………………………………………………..68
4.10.1 Implications for Practice…………………………………………………………………………………….68
4.10.2 Implications for Research …………………………………………………………………………………..68
4.11 Acknowledgements……………………………………………………………………………………………………..69
4.11.1 Contributions of Authors……………………………………………………………………………………69
4.11.2 Declarations of interest ……………………………………………………………………………………..70
CHAPTER 5: RESULTS ………………………………………………………………………………………. 71
5.1 Modified Beliefs about Aromatherapy Scale …………………………………………………………………..71
5.1.1 Participants in Delphi Process……………………………………………………………………………..71
5.1.2 Delphi Process Results……………………………………………………………………………………….72
5.2 Testing and Validating the Nurses’ Beliefs About Aromatherapy Scale ………………………………76

5.2.1 Sample Characteristics ………………………………………………………………………………………76
5.2.2 Validity and Reliability of the N‐BAAS ………………………………………………………………….78
5.2.3 Mean Levels of Belief about Aromatherapy………………………………………………………….80
5.2.4 Relationships Among Demographic Variables and N‐BAAS …………………………………….80
5.3 Summary……………………………………………………………………………………………………………………81
CHAPTER 6: DISCUSSION ………………………………………………………………………………. 82
6.1 Effectiveness of Aromatherapy to Treat Postoperative Nausea and Vomiting…………………….82
6.1.1 Summary of Systematic Review Results……………………………………………………………….82
6.1.2 Levels of Evidence in the Systematic Review ………………………………………………………..84
6.1.3 Adverse Effects Reported in Studies Included in the Systematic Review…………………..84
6.1.4 Agreement and Disagreement with Other Studies or Reviews………………………………..85
6.1.5 Complementary Therapies Research……………………………………………………………………86
6.1.6 Gaps in the Current Evidence Base………………………………………………………………………87
6.2 Modification of the Beliefs about Aromatherapy Scale…………………………………………………….88
6.2.1 The Delphi Panel……………………………………………………………………………………………….88
6.2.2 Delphi Process………………………………………………………………………………………………….89
6.2.3 Additional Items ……………………………………………………………………………………………….90
6.2.4 Deleted Items…………………………………………………………………………………………………..91
6.3 Testing of the Modified n‐baas Tool………………………………………………………………………………92
6.3.1 Psychometric Testing of the N‐BAAS Tool…………………………………………………………….92
6.3.2 Representativeness of the Sample ………………………………………………………………………93
6.3.3 Factor Analysis for Determining Construct Validity………………………………………………..94
6.3.4 Sub‐scales………………………………………………………………………………………………………..95
6.3.5 Future Modifications to the Scale ……………………………………………………………………….96
6.3.6 Nurses’ Beliefs About Aromatherapy …………………………………………………………………..97
6.4 Summary……………………………………………………………………………………………………………………98
CHAPTER 7: CONCLUSIONS……………………………………………………………………………. 99
7.1 Conclusions………………………………………………………………………………………………………………..99
7.1.1 Is aromatherapy an effective treatment for postoperative nausea and vomiting?…….99

Aromatherapy for postoperative nausea and vomiting ix
7.1.2 Can aromatherapy be used to treat postoperative nausea and vomiting with
clinical safety comparable to that of pharmacological antiemetics? ………………………..99
7.1.3 Is the Beliefs About Aromatherapy Scale relevant to nursing and midwifery
practice or does it require modification before use with a population of nurses?……100
7.1.4 Is the modified Nurses’ Beliefs About Aromatherapy Scale valid and reliable?………..100
7.2 Limitations ……………………………………………………………………………………………………………….100
7.2.1 Limitations of the Systematic Review…………………………………………………………………100
7.2.2 Limitations of the Delphi Process………………………………………………………………………102
7.2.3 Limitations of the Instrument and Survey …………………………………………………………..102
7.3 Implications for Clinical Practice………………………………………………………………………………….103
7.4 Implications for Research …………………………………………………………………………………………..105
BIBLIOGRAPHY107
APPENDICES 125
Appendix A ………………………………………………………………………………………………………………125
Appendix B ………………………………………………………………………………………………………………126
Appendix C ………………………………………………………………………………………………………………128
Appendix D ………………………………………………………………………………………………………………131
Appendix E ………………………………………………………………………………………………………………132
Appendix F ………………………………………………………………………………………………………………134
Appendix G ………………………………………………………………………………………………………………136
Appendix H ………………………………………………………………………………………………………………138
Appendix I ………………………………………………………………………………………………………………139
Appendix J ………………………………………………………………………………………………………………141
Appendix K ………………………………………………………………………………………………………………143
Appendix L ………………………………………………………………………………………………………………144
Appendix M ………………………………………………………………………………………………………………146
Appendix N ………………………………………………………………………………………………………………168
Appendix O ………………………………………………………………………………………………………………171

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