1. PALLIATIVE CARE SERVICE Joy Hesselgrave, MSN, RN, CPON COMPLEMENTARY APPROACHES TO SYMPTOM MANAGEMENT

2. PALLIATIVE CARE SERVICE DISCLOSURES Requirements for successful completion: You must attend the entire presentation You must sign the attendance roster You must complete and return the evaluation at the end of the presentation There are no conflicts of interest for this activity. There are no financial relationships or commercial interest in products or services related to this activity This activity is not co-provided There are no off-label products discussed

3. PALLIATIVE CARE SERVICE Describe complementary interventions that may be used for symptom management Considerations for procedural pain Positions of comfort Aromatherapy Massage Mindfulness/Guided imagery/Distraction OBJECTIVE

4. PALLIATIVE CARE SERVICE Numb the skin (topical anesthetic) Sucrose or breastfeeding (0-6 months) Positioning – do NOT hold children down Distraction Communication PROCEDURAL PAIN

5. PALLIATIVE CARE SERVICE PARENT INVOLVEMENT HELPS THE MOST Behaviors that are not helpful Empathy, criticisms, apologies, giving complete control to the child, and reassurance are associated with increased child stress Behaviors that are helpful Making parent a coach, use of humor (jokes), commands to use coping strategies, and nonprocedural talk addressed to the child are associated with decreased behavioral stress.

6. PALLIATIVE CARE SERVICE POSITIONS OF COMFORT Provides comfort with a secure, hugging hold Supports close physical contact with caregiver Sitting position promotes sense of control When possible, use treatment room for painful procedures

7. PALLIATIVE CARE SERVICE NON PHARMACOLOGIC TOOLS Buzzy Shot Blocker

8. PALLIATIVE CARE SERVICE Use of essential oils (aromatic compounds) for therapeutic purposes Botanical extracts from plants Found in leaves, stems, flowers, roots, seeds, bark, needles, fruit, berries, resins Resource: Gillette Children’s Hospital, MN CLINICAL AROMATHERAPY

9. PALLIATIVE CARE SERVICE May be administered topically May be administered orally May be administered by inhalation: Moist – facial steam bath Simple diffusion: 2-3 drops of essential oil in cotton ball, band-aide or tissue Spray bottle – essential oil in water or water and alcohol, shake and spray Diffusers – flame, electric diffuser, lamp ring, air diffuser METHOD OF ACTION

10. PALLIATIVE CARE SERVICE METHOD OF ACTION – INHALATION Pharmacologic Direct and intrinsic ability to interact with the CNS and endocrine system Enters the bloodstream via nasal or lung mucosa or diffuses directly into the olfactory nerves and limbic system Psychological Olfactory nerves have close connection to the limbic system (emotion, memory) Essential oils (any odor) exert effects via emotional learning, conscious perception and belief/expectation

11. PALLIATIVE CARE SERVICE Ginger – nausea, vomiting, or upset stomach, arthritis, constipation True Lavender – anxiety, pain, insomnia, muscle spasms, promotion of comfort and relaxation Mandarin – insomnia, indigestion, nausea Bergamot – relaxation and calm Peppermint, spearmint, lemon- nausea COMMON ESSENTIAL OILS USED FOR SYMPTOMS

12. PALLIATIVE CARE SERVICE Dilution of essential oils Storage of supplies Age of children – some institutions do >2 years and >20 kg Assess for asthma, allergies or other contraindications for inhaled route CONSIDERATIONS

13. PALLIATIVE CARE SERVICE Aromatherapy certification via courses approved by the: National Association for Holistic Aromatherapy Alliance of International Aromatherapists or the American Holistic Nurses Association WAYS TO BECOME EDUCATED ON AROMATHERAPY

14. PALLIATIVE CARE SERVICE Massage has shown improvements in mood, anxiety in as little as one session Reduced CINV in 4-18 year old children ( Mazlum, S. et al, 2013 ) Massage in children decreased pain and anxiety related to IT therapy and BMA (Celebigly, A. et al, 2014) May use aromatic oils for massage MASSAGE

15. PALLIATIVE CARE SERVICE ABDOMINAL MASSAGE FOR CONSTIPATION I love you abdominal massage Light rhythmic pressure from right to left on abdomen

16. PALLIATIVE CARE SERVICE Used to enhance mind-body-spirit connections Mobile apps for distraction, relaxation, guided imagery Ballonimals Healing buddies comfort kit Simply being Koi pond Ref. Dr. Stefan Friedrichsdorf MIND BODY THERAPIES

17. PALLIATIVE CARE SERVICE Increase your repertoire in one non-pharmacologic area Educate your patients Share one thing you have learned with your peers Adopt the 5 minute in-service YOUR NEXT STEPS

18. PALLIATIVE CARE SERVICE COMMENTS/QUESTIONS?