Pre‐procedure

ActionRationale

1. 1.Show
   Introduce self to patient and carers.
   To establish professional and clinical rapport and comply with professional codes of conduct (CSP [46], C).
2. 2.Show
   Gain consent from the patient to assess their medical and psychosocial history.
   To understand the background for the presentation and any treatments undergone to treat the reversible causes of breathlessness. E
3. 3.Show
   Carry out an assessment of breathlessness including taking a measure of breathlessness at baseline using a 10‐point visual analogue scale and a subjective descriptor from the patient if indicated.
   To obtain a baseline objective and subjective assessment of breathlessness so change can be measured (Booth et al. [19], R).
4. 4.Show
   Discuss the use of aroma stick inhalers in the cancer setting. Explain and discuss the procedure with the patient.
   To ensure that a trial of the intervention is acceptable and could be effective for the patient. That they understand the procedure and give their valid written consent (NMC [199], C).
5. 5.Show
   Gain agreement to discontinue the intervention if it is not found to be clinically effective on that day.
   To ensure that the patient is not left with equipment of no benefit. E
6. 6.Show
   Introduce the basic principles of resting positions as shown in Figure 27.26.
   To promote an energy‐efficient position for the duration of the intervention (Galbraith et al. [109], R).

Procedure

1. 7.Show
   Introduce the aroma stick inhaler pre‐loaded with the essential oil mixture and demonstrate its use by removing the outer casing, holding the stick beneath the nose and inhaling. Replace the casing after use.
   To give a cooling sensation and stimulate the area innervated by the second branch of the trigeminal nerve (Booth et al. [19], R).
2. 8.Show
   Ask the patient what they felt the effect of the intervention was and record the measure of breathlessness again (e.g. VAS).
   To establish any clinical effect due to the intervention (Dyer et al. [95], R).
3. 9.Show
   If the essential oils delivered by the aroma stick inhaler were thought to be effective by the patient subjectively or objectively and they want to continue to use the intervention, teach them to use the device for the best clinical effect.
   To enable the patient to continue the intervention as a tool to self‐manage their breathlessness (Dyer et al. [95], R).
4. 10.Show
   Teach the patient, family or carers to use and clean the device. Provide written instructions.
   To provide ownership of the intervention to patients and their carers and enable ongoing practice (Schneiders et al. [250], C).

   To ensure that the patient can continue to use the device safely.
5. 11.Show
   If the intervention was not subjectively or objectively effective for the patient, discuss this with the patient. If appropriate, suggest the intervention is discontinued.
   In order not to increase any treatment burden for the patient or their carers. E

Post‐procedure

1. 12.Show
   Document the intervention and its effect in the patient's record.
   Legal requirement of professional body and employing institution (NMC [202], C).
2. 13.Show
   Review the session as per procedure after an agreed interval to modify or discontinue the intervention as required.
   To enable informed expert review and modification of the intervention as required. E