PICOT: For adult surgical oncology patients at White Plains Hospital Center for Cancer Care, does the implementation of aromatherapy in the preoperative setting, compared to current practice, impact anxiousness in 8-10 weeks?
Please discuss the importance of engaging and educating stakeholders on your quality improvement initiative.
The first stage is problem identification. When identifying the need for a nonpharmacologic approach to preoperative anxiousness, the DNP student took into consideration the needs of the practicum site. Many patients regularly take antianxiety medication and are instructed to refrain from taking it the day of surgery. Currently, there is no formal practice in place managing these symptoms preoperatively. Stakeholders were a part of the problem identification, therefore having them included in the process promotes engagement and excitement in the quality improvement initiative.  
What is your plan for education of the stakeholders?
The DNP student reviewed the literature to extract the best evidence to support the management of preoperative anxiousness. Upon disseminating the literature, utilizing aromatherapy as a cost-effective, simple, and nonpharmacologic intervention emerged as a fruitful intervention (Abbaszadeh et al., 2020; Abdelhakin et al., 2020; Beyliklioglu & Arslan, 2019; Croke, 2020; Franco et al., 2016). Next, the DNP student adapted this knowledge to local content. Knowing that there lacks a current practice to address preoperative anxiousness, this was an opportunity to integrate a strong, literature-supported intervention. Providing this well identified problem and supported intervention, made educating the stakeholders quite easy. Presenting each stakeholder, personally, with the information obtained was the plan for educating these individuals.  
How will you implement this plan?
Organizing regular meetings and educational sessions, held by the DNP student will be the plan for education. I prefer and would like to hold these meetings in person if possible, so information does not get lost in translation. Educational handouts about the project will also be useful.
How will you foster and continue enthusiasm for your intervention?
Sustainability requires enthusiasm, continuous work, feedback, and revision. Dissemination of results and gained information from the DNP project will serve as a foundation for sustainability. Positive patient feedback and increased patient satisfaction will add to the likelihood of maintaining this proposed intervention. Utilizing the survey information on anxiousness could potentially lead to further exploration of this widespread emotion. The DNP student will serve as an ambassador and cheerleader for the project, while keeping everyone focused and excited about the intervention.  
Provide your instructor and student colleagues with an update on your implementation plans for your DNP Project. Share any successes, challenges, or barriers you experienced this week.
I am having a hard time with the IRB at my institution. They keep on classifying my DNP project as “research” or “study” and it seems as though no one is distinguishing between the two. I was out of the office for a few days, hoping to come back to my project being sent to expedited review, although to my dismay and disappointment it has not. I currently have meetings pending with two individuals to help me navigate through this VERY frustrating process. To be honest, this is a huge deterrent for future change, due to the unfriendly process.
Abbaszadeh, R., Tabari, F., & Asadpour, A. (2020). The effect of lavender aroma on anxiety of patients having bone marrow biopsy. Asian Pacific Journal of Cancer Prevention, 21(3), 771-775. https://doi.org/10.31557/APJCP.2020.21.3.771 (Links to an external site.)
Abdelhakim, A.M., Hussein, A.S., Doheim, M.F., & Sayed, A.K. (2020). The effect of inhalation aromatherapy in patients undergoing cardiac surgery: A systematic review and meta-analysis of randomized controlled trials. Complementary Therapies in Medicine, 48, 1-8. https://doi.org/10.1016/j.ctim.2019.102256 (Links to an external site.)
Beyliklioglu, A. & Arslan, S. (2019). Effect of lavender oil on the anxiety of patients before breast surgery. Journal of PeriAnesthesia Nursing, 34(3), 587-593. https://doi.org/10.1016/j.jopan.2018.10.002 (Links to an external site.)
Croke, L. (2020). Nonpharmacologic strategies to help reduce preoperative patient anxiety. AORN Journal, 111(2), p8-p10. https://doi.org/10.1002/aorn.12970


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