RESEARCH PROPOSAL TOPIC An exploration of lavender oil and agitated behaviour in dementia patients. A phenomenological study.

This research seeks to explore the lived experiences of reducing agitated behaviour in patients with dementia with the use of lavender oil through the perception of nurses. This research wants understand if there is any reduction of agitated behaviour in the application of lavender oil (aromatherapy) through the perception of the nurses. This would be explored by interviewing nurses about their perception of lavender oil reducing agitated behaviour. Dementia patients suffer from many behavioural and psychological symptoms of dementia (BPSD). Among the many identified symptoms one of the BPSD is agitation (Manju T. Beier, 2007). In an attempt to reduce agitation sedatives such as neropleptics which have great adverse affects despite their limited efficacy (Raskin, 1985; Salzam1987 cited in Smallwood J. et al., 2001). These side affects include sedation extrapyramidal signs, falls, detrimental impact on quality of life, and possible acceleration in cognitive decline (Manju T. Beier, 2007). Broker (1997) suggested that aromatherapy represented an alternative intervention strategy to neuroleptic medication (Cited in Smallwood J., Brown R., Coulter F., Irvine E., and Copland C., 2001). The international jornal of geriatric psychiaty stressed that Alternate treatments with few side effects are desperately needed (Holmes C., Hopkins V., Hensford C., Maclaughlin V., Wilkinson D., and Rosenvinge H. 2002). LITERATURE REVIEW Mirea and Cunnings, (2000) noted that between 18-65% of people with dementia experience agitated behaviour (cited in Holmes C., et al, 2002). An experiment conducted by Holmes C., et al (2002) hypothesised; lavender oil in the form of an aroma stream (stream of air allows the diffusion of lavender oil) would have favourable effect on agitated behaviour in patients with severe dementia. The experiment concluded that aromatherapy with lavender oils showed modest efficacy in the treatment of agitated behaviours in-patients with sever dementia. The majority of patients showed either improvement (60%) or no change in agitated behaviour (33%) of the total fifteen subjects. It noted that a larger study exploring different modes of administration and the characteristics of responders were needed (Holmes C., et al 2002). Agitation Agitation is a state of anxiety accompanied by motor restlessness. Agitated behaviours can be manifested dementia patients as well as cognitively intact elderly people (Koss et al., cited in Mansfield C.J., 2007) and by those with psychiatric disorders. Agitation in dementia is exclusive in that it is correlated with the progression of the dementia itself and with the abilities and disabilities affected by this progression agitation is linked with the progression of dementia. The three main types of agitation are verbal/vocal behaviour, non-physical agitation and physical aggression (Mansfield C. J., 2001). Aromatherapy Aromatherapy is using essential oils (each having its own constituents) that interact with the

bodys chemistry, which than intern effects certain system as a whole it isnt just the aroma but also the way the oil chemically interacts with the body and the physical changes that occur. There are three distinct modes of action pharmacological, psychological, and physiological (Lawless J., 1997 p. 23). Lavender oil and its effects on agitated behaviour; Lavender oils acts as an analgesic, carminative sedative agent which influences or enhances the reduction of agitated behaviour. Its key qualities is soothing, sedative, antidepressant, calming, relaxing, balancing, restorative, cephalic, appeasing, cleansing, purifying and reduces nervous tension and stress (Lawless J., 1997 p. 196). In the experiment conducted by Smallwood J., et al (2001) it was predicted that as lavender oil is a sedative both aromatherapy conditions, aromatherapy and massage (AM), would reduce disordered behaviour with the aromatherapy massage condition eliciting the strongest effect. They found that AM produced a reduction in motor behaviour. They concluded that this reduction in behaviour represented a reduction in agitation (Smallwood J., Brown R., Coulter F., Irvine E., and Copland C., 2001). DEFINITION OF THE RESEARCH PROBLEM What are the affects of lavender oil and agitated behaviour? Research aims 1. To explore nurses perception of using lavender oil and effect of agitated behaviour 2. To increase our knowledge of using an alternative means of reducing agitated behaviour. 3. To improve our knowledge about lavender oil and agitated behaviour 4. Understand more about the underlying uses of aromatherapy and how they actually work. 5. To open opportunities to health care practitioners to consider an alternate means of reducing agitated behaviour. RESEARCH DESIGN Qualitative research is a holistic approach to questions, which acknowledges that human realities are complex. The focus of the qualitative method is on human experiences. The research strategies used usually involve contact with people, contact with people in there settings where they normally spend their time. Researchers are predominantly involved with subjects. The strategies of collecting data are through participant observation and in-depth unstructured interviews. Qualitative research is stated questions about human experience and realities through contact with persons in their natural environment this produces a rich descriptive data that helps understand peoples feelings (Munhall L. P., and Boyd O. C., 1993 p.69). Phenomenology Phenomenology seeks deeper and fuller meaning of the experience of the participants of a particular phenomenon (Morse M. J., and Field A. P., 1996 p. 124). Its purpose is to describe and explore the essence of behaviour based on preconceived thoughts in enhancing human understanding (Morse M. J., and Field A. P., 1996). In this research, examination of the lived experiences of agitated dementia patients by using lavender oil as treatment is explored through the perception of nurses.

Phenomenology researchers ask, what is the essence of this phenomenon as experienced by these people and what does it mean. Phenomenologist investigate subjective phenomena in the enological approach is especially useful when a phenomenon has been poorly defined or conceptualise (Polit F. D., and Beck T. C., 2006 p. 219). There has been minimal research to find an alternate treatment for agitated behaviour in dementia patients and this is the purpose of this research. A phenomenon is implicated to present what is known and what is not known to than inform health care professional about the phenomenon explored. In an attempt to bracket this research will maintain a reflexive journal. This is an effort to bracket the world and presuppositions in an effort to confront the data in pure form, looking and at the research without personal preconceived ideas. Bracketing therefore attempts to decreases the variables and prevent bias (Polit F. D., and Beck T. C., 2006 p. 220). TARGET POPULATON, SAMPLING Sample design Purposeful sampling judgement about which might be the most useful or representative (Berry C., 2007). The proposed research will aim to interview 6 women. The inclusion criteria of participants in this research are; 6 nurses working with agitated patients Aged care facility Registered nurses with at least three years of experience Registered nurses within the central business district of Melbourne The exclusion criteria; Nurses that arent located in an aged care facility not working with agitated patients. Nurses in rural areas Nurses with less than three years experience COLLECTION DATA The collection of data will be in the form of an interview (data collection encounter in which one person asks questions) Berry C., (2007). Face to face interview will provide a free exchange of ideas and lend itself to ask more complex questions. The interview will be taped recorded, it is estimated that the interview would take 35minuets. A focused interview (semi-structured question) will be prepared. It will be composed of topics or broad questions that will be addressed in the interview. This ensures that all areas are covered as it also facilitates the participants to speak about the topic of interest, lavender oil reducing agitated behaviour (Polit F. D., and Beck T. C., 2006 p.291). The open-ended question will allow the nurses to explore and comment on the effects of aromatherapy and agitated behaviour. It is also important to create an atmosphere where the nurses are given time to reflect and to ensure and encourage participants to talk freely about the

topic on the treatment of lavender oil reducing agitated behaviour. The second interview will be following all the data collection to verify and clarify the responses of the nurses in observing the use of lavender oil and agitated behaviour. Trustworthiness Trustworthiness is the procedure or method of insuring the nurses response is accurate and valid. This will guarantee that each participants answer is accurate and valid for the analysis of data. Lincoln and Guba (1985) have established four criteria for establishing the trustworthiness of qualitative data credibility dependability, confirmability and transferability (Polit F. D., and Beck T. C., 2006 p.332). Ethics The researcher will obtain ethics clearance from the Victoria university ethics committee and the school of nursing and midwifery at Victoria University. In addition informed consent will be obtained from each participant and they will be told the full purpose and extent of the interview process. This will include a signed consent from each participant. 1. Withdrawal. Participants will be informed that withdraw from the interview/ research process at any stage is possible. 2. Confidentiality and privacy. Participants names will not appear or connect with any of the material once interpreted. And any comments that would identify a participant will be removed from the final research paper. Discussions or any event relating to the research process will not be communicated or documented with another. 3. Referral. A list of relevant health care professional to each participant will be provided if they feel it is needed at any time during the research process. COLLECTION OF DATA Following the ethics approval participants for the research will be found within the cental business district of Melbourne. The participants would come from an aged care facility where the nurses are caring for patients suffering from agitated behaviour. An invitation by telephone and mail will outline the purpose of the study, the criteria for research participants, confidentiality and a statement about withdrawal. The contact details will identify the university and faculty of the health sciences. After subsequent contact and verbal confirmation from the potential participant a letter will be sent, outlining in more detail of the research and the next step involved. An arrangement of an interview with the participant would take place and the interview would occur at the participants aged care facility that they are working in. DATA ANALYSIS In preparation for analysis Crabtree and Miller (1999) have suggested several analysis styles. The research will be using the editing analysis style as it acts as interpreters who read through texts in search of meaningful segments (Cited in Polit F. D., and Beck T. C., 2006 p. 398).

Stage 1 This phase looks at interpreting the texts that are read in search of meaningful segments. Stage 2 These meaningful segments are to be identified and reviewed to ensure that an overview of the topic is explored. Stage 3 The Development of a category scheme and corresponding codes is implemented to ensure that it can be used to sort and organise data. Stage 4 The next stage is conducted to search for the patterns and structures to connect the thematic categories. Stage 5 The next stage is a process of fitting data together, of making the invisible obvious, of liking and attributing consequences to antecedents, its a process of conjuncture, and verification of correction and modification of suggestion and defence (Morse and field 1995 cited in Polit F. D., and Beck T. C., 2006 p398 ) . Morse and field (1995) proposed stages of qualitative analysis including comprehending, synthesizing, theorizing and recontextualizing (Polit F. D., and Beck T. C., 2006 p.398) INTERPRETAION, RESULTS AND CONCLUSION. The aim of this research was to explore if there were any reduction in agitated behaviour with the use of lavender oil through the perceptions of the nurses. The researcher hopes to understand the lived experiences of reducing agitated behaviour in patients with dementia with the use of lavender oil. The findings of this research will be written and published in academic journals that will expand on the knowledge related patients suffering from agitated behaviour. REFERENCE LIST Journals Bleasel N., Tate B., and Rademark M., (2002) Allergic contact dermatitis following exposure to essential oils. Australian journal of dermatology 43: 211-213 Retrieved April 4th 2007, from CINAHL database Holmes C., Hopkins V., Hensford C., Maclaughlin V., Wilkinson D., and Rosenvinge H., (2002) lavender oil as a treatment for agitated behaviour in severe dementia: a placebo controlled study. International journal of geriatric psychiatry 17: 305-308 Retrieved April 4th 2007, from CINAHL database Manju T. Beier (2007) Pharmacotherapy for behavioural and psychological symptoms of dementia in the elderly. American society of health system pharmacists 16: 10-16 Retrieved April 4th 2007, from CINAHL database

Mansfield C. J., (2001) managing agitation in elderly patients with dement Geriatric times, Volume II issue 3 Retrieved April 24th 2007 from CINAHL Smallwood J., Brown R., Coulter F., Irvine E., and Copland C., (2001) Aromatherapy and behaviour disturbance in dementia: a randomized controlled trial. International journal geriatric psychiatry 16: 1010-1013 Retrieved April 9th 2007, from CINAHL database Snow L., Hovanec L., and Brandt J., (2004) A controlled trial of aromatherapy for agitation in nursing home patients with dementia. The journal of alternative and complementary medicine 10: 431-437 Retrieved April 9th 2007, from CINAHL database The brown university geriatric psychopharmacology update (2002) innovation in alternative medicine; aromatherapy may be safe and affective for management of agitation in severe dementia. Volume 6 No.9 ISSN 1529-2584 Retrieved April 9th 2007, from CINAHL database Books Lawless J., (1997) The complete illustrated guide to aromatherapy; a practical approach to the use of essential oils for health and well-being Australia: element books limited Morse M. J., and Field A. P., (1996) Nursing research; the application of qualitative approaches United States of America; Chapman and Hall Mungall L. P., and Boyd O. C., (1993) Nursing research; a qualitative perspective United States of America: National league for nursing press Polit F. D., and Beck T. C., (2006) essentials of nursing research; methods, appraisal and utilization (6th Ed) United States of America; Lippincott Williams and Wilkins Porth Mattson C., (2005) Pathophysiology; concepts of altered health states (7th Ed) United States of America: Lippincott Williams and Wilkins Wildwood C., (1996) Encyclopaedia of aromatherapy Spain: Bloomsbury. Other sources Berry C., (2007) introduction to research practice lecture notes.