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Using essential oils with vulnerable people
There is no doubt that if essential oils are used properly, they are safe. However, when used inappropriately, they can cause skin irritation, sensitisation, headache and nausea. For active and healthy people, this would not be a problem, irritation can be easily treated by washing off the oils, headaches and nausea can be avoided by choosing to finish treatment and moving into a ventilated area.People with profound and multiple handicaps, inactive through immobility, often have slower metabolism requiring a weaker dilution of essential oils for massage. They may also unable to communicate discomfort in the normal way, but may resort to irritability or challenging behaviour which may not manifest itself until later on. This is why care staff using aromatherapy techniques on this type of recipient need to be much more aware of the hazards and potential for harm.
The nursing profession in the UK has strict guidelines for the practice of Complementary Therapies - all practitioners having to be sure of their own competence, suitably qualified or working under the guidance of someone that is. Day services and other organisations employing non-nursing staff are different however. The use of essential oils may be left up to individual staff. I have seen many cases of staff doing an aromatherapy session using essential oils for hand and foot massages without any real guidance or training. Irritation, headaches and nausea would not necessarily occur during, or immediately after a treatment - so how do we know whether adverse effects are not being experienced later on?. It would take a very observant carer to relate a weekly outburst of challenging behaviour with the inappropriate use of essential oils earlier that day.
Care needs to be taken when storing and using essential oils in any workplace, but there are extra risks which much be assessed properly when caring for the learning disabled or elderly-confused client group. An unattended pot of massage oil could easily be mistaken for a pot of medicine by a confused client. Essential oils must secured away safely when not in use to safe-guard clients finding them and using without supervision. The only way to prevent this is to have a proper policy in place for staff using essential oils with vulnerable clients.
Health and Safety in the workplace
Any substance which has the potential to do harm is covered by Health and Safety legislation - this includes essential oils being used with vulnerable clients, particularly by staff who may not be trained in their correct use. Managers and teachers have an obligation to fulfil the requirements of the Health and Safety at Work Regulations 1992 by identifying potential risk through assessments, then introducing a systematic approach to minimise that risk. Ignorance is not an excuse - all managers (and employees) being held accountable for health and safety at their place of work.
Suggested criteria to protect vulnerable clients from the misuse of oils
As many essential oils are available freely to the general public, it would not be appropriate to limit there use to clinical practitioners only.
Risk assessment
This can only be done by someone who is aware of the potential for harm with your client group. Documented risk assessments and plans of action will satisfy the Health and Safety Directorate that responsibilities are being taken seriously.
Suitable training
Suitable training should not need to be a clinical qualification, but should be a proven awareness of the safe use, storage, and therapeutic effects of essential oils - at best under the guidance a fully qualified Aromatherapist. Training and support may also be obtainable from NVQ courses from reputable colleges.
Appointed person
Appointed persons need to have an understanding of Health and Safety issues regarding the use and storage of oils. They need the ability to supervise staff, and recognise the need to share planning with other professionals (Aromatherapist, School Nurse, Physiotherapist, Speech Therapist, GP etc). The also need to take responsibility to prepare and evaluate individual programmes for each client. Advice should be taken from a qualified Aromatherapist as to which oils to use and how to use them.
Permission from the GP/Consultant
Before using essential oils on clients, permission needs to be obtained for those with physical disabilities, epilepsy, other debilitating illnesses/conditions and severe communication problems, and those on medication and other intervention programmes.
Permission from the parents/carers
Parents and carers need to be informed if essential oils are being use on the people they care for. They need to be satisfied that it is a safe and well informed practice. Get permission in writing and invite them to a session to see the benefits. Include them in programme plans and evaluation of treatment. Also ask about allergies to wheat and nut-base products to eliminate use of wheatgerm and nut-based products.
There have also been recent concerns raised by health practitioners as to the issue of consent when using strong-smelling essential oils in shared bedrooms, and particularly with the over-use of lavender oil to help 'promote sleep' which will act as a stimulant in excessive quantities.
Physical disabilities and massage
Seek input from GPs, Consultants, the Physiotherapist and/or suitably qualified massage therapist on contraindications to massage.
Programme plans
To avoid the misuse of essential oils, each individual should have a specific programme plan listing objectives, oils to be used, dilution, method of application, the intended therapeutic effect, any possible contraindications. Sessions should be evaluated regularly with staff sharing ideas on how to promote more opportunities for participation and enjoyment together.
See Aromacaring Publications: Using Essential Oils in the Workplace