Geranium (P. graveolens) Essential Oil Reduces Fatigue in ICU Nurses

by | Aug 29, 2023 | COVID-19, Essential Oils, Stress

Written by Taylor Woosley, Staff Writer. Results of this double-blind, placebo-controlled, randomized trial of 84 nurses working in critical care during COVID-19 shows that inhalation of P. graveolens essential oil significantly reduced fatigue scores in subjects compared to placebo. 

essential oilsThe corona virus disease 2019 (COVID-19) pandemic is a substantial health burden that has major implications for public health globally1. As the pandemic accelerates, global health care systems have become overwhelmed, leading to great psychological pressure on nurses in the care of critically ill patients with COVID-192. Research has revealed that more than 40% of healthcare personnel reported that they exhibited anxiety symptoms; more than 46% had reported depression, 32% reported insomnia, and 69% had high levels of stress3.

Aromatherapy is effective in reducing stress levels through the relaxation resulting from exposure to the aroma of essential oil that influence the decrease in the activity of the sympathetic nervous system and the stimulation of the parasympathetic4. Geranium (P. graveolens) essential oil has been used in both physiological and psychological complications, including anxiety, insomnia, restlessness, nervousness, and high blood pressure5. Geranium oil contains the bioactive compounds citronellol, geraniol, and linalool, which may support the treatment of some symptoms of COVID-196.

Karimi et al. conducted a double-blind, placebo-controlled, randomized trial to analyze the effect of P. graveolens essential oil on the fatigue and sleep quality of ICU nurses working during the COVID-19 pandemic. Subject inclusion consisted of having at least two years of nursing experience and three months work experience in the ICU of COVID-19 patients, with a rotational schedule with at least 3-night shifts, who had no history of respiratory allergies or allergies to herbal and aromatic products, with a score higher than 3 on the Visual Analogue Fatigue Scale (VAS-F).

Nurse participants were divided into two groups, either the P. graveolens group or the placebo, by stratified block randomization method to have similar gender and body mass index between groups. The P. graveolens essential oil contained the main constituents citronellol (27%), linalool (1.1%), geraniol (25%), and cintronellyl formate (8.4%). The placebo group was given a refined and odorless sunflower oil. The intervention group inhaled one drop of P. graveolens essential oil on a linen pad which was placed between a simple surgical mask and their protective mask for 20 minutes. The placebo group followed the same protocol with one drop of pure sunflower oil on a linen pad between the masks.

The VAS-F was utilized to determine the fatigue score 30 minutes before inhaling the oil, immediately after inhalation, and then 60 minutes after. The aromatherapy was completed for two 20-minute sessions during each nurse shift for three consecutive work shifts. Subjects completed the Verran and Snyder-Halpern (VSH) Sleep Scale the morning of the intervention to determine sleep quality. An independent t-test was utilized to compare the mean score of quantitative variables. Repeated measure ANOVA was used to compare the changes of quantitative variables between two groups at different times. Furthermore, depression was assessed as a confounding variable using the Beck Depression Inventory short form (BDI-SF).

42 subjects from the P. graveolens group and 42 subjects from the placebo group were included in the final analysis. 85.7% of participants were female, married (56%), and had a bachelor’s degree (94%). Significant findings of the study are as follows:

  • A significant difference was noted between the mean fatigue score changes between the two groups over time (p < 0.05).
  • The P. graveolens group experienced a significant decrease in the mean fatigue score one hour after the intervention compared to 30 minutes before when compared to the placebo group (p < 0.004).
  • No significant differences were noted between the nurses’ mean total sleep score in the two groups (p = 0.458).

Results of the study show that P. graveolens essential oil reduces fatigue in critical care nurses. However, no significant improvements regarding sleep quality were found in either group. Study limitations include COVID-19’s effect on participant completion of the study due to illness, the difficulty of blinding essential oils based on odor, and the lack of subject sampling during night shifts.

Source: Karimi, Nasrin, Shirin Hasanvand, Afsaneh Beiranvand, Mohammad Gholami, and Mehdi Birjandi. “The Effect of Aromatherapy with Pelargonium graveolens (P. graveolens) on the Fatigue and Sleep Quality of Critical Care Nurses during the Covid-19 Pandemic: A Randomized Controlled Trial.” EXPLORE (2023).

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Posted August 29, 2023. 

Taylor Woosley studied biology at Purdue University before becoming a 2016 graduate of Columbia College Chicago with a major in Writing. She currently resides in Glen Ellyn, IL.

References:

  1. Baraka AAE, Ramadan FH, Hassan EA. Predictors of critical care nurses’ stress, anxiety, and depression in response to COVID-19 pandemic. Nurs Crit Care. Mar 2023;28(2):177-183. doi:10.1111/nicc.12708
  2. Shen X, Zou X, Zhong X, Yan J, Li L. Psychological stress of ICU nurses in the time of COVID-19. Critical care (London, England). May 6 2020;24(1):200. doi:10.1186/s13054-020-02926-2
  3. Chen R, Sun C, Chen JJ, et al. A Large-Scale Survey on Trauma, Burnout, and Posttraumatic Growth among Nurses during the COVID-19 Pandemic. Int J Ment Health Nurs. Feb 2021;30(1):102-116. doi:10.1111/inm.12796
  4. Montibeler J, Domingos TDS, Braga EM, Gnatta JR, Kurebayashi LFS, Kurebayashi AK. Effectiveness of aromatherapy massage on the stress of the surgical center nursing team: a pilot study. Rev Esc Enferm USP. Aug 23 2018;52:03348. Efetividade da massagem com aromaterapia no estresse da equipe de enfermagem do centro cirúrgico: estudo-piloto. doi:10.1590/s1980-220×2017038303348
  5. Senthil Kumar KJ, Gokila Vani M, Wang CS, et al. Geranium and Lemon Essential Oils and Their Active Compounds Downregulate Angiotensin-Converting Enzyme 2 (ACE2), a SARS-CoV-2 Spike Receptor-Binding Domain, in Epithelial Cells. Plants (Basel). Jun 19 2020;9(6)doi:10.3390/plants9060770
  6. Torres Neto L, Monteiro MLG, Fernández-Romero J, Teleshova N, Sailer J, Conte Junior CA. Essential oils block cellular entry of SARS-CoV-2 delta variant. Sci Rep. Nov 30 2022;12(1):20639. doi:10.1038/s41598-022-25342-8