Iran Journal of Nursing

Background & Aims: Endoscopy causes significant anxiety in the patients in the clinical setting. Relieving anxiety through non-pharmacological methods is an important task of nurses. Nurses take the steps to reducing the anxiety of these patients before performing diagnostic and therapeutic procedures. Aromatherapy is a complementary medicine technique used to alleviate anxiety. Aromatherapy involves the use of the essential oils of aromatic plants or other compounds to enhance health and recovery. Lavender essential oil is used in aromatherapy, which stimulates the parasympathetic system and induces relaxation by reducing the heart rate, respiration, and blood pressure. The present study aimed to assess the effect of aromatherapy with lavender essential oil on the preoperative anxiety of endoscopy candidates in Iran.
Materials & Methods: This single-blind clinical trial was conducted at the endoscopy department of Razi Hospital in Rasht city, Iran during January 2018-August 2019. The sample population included 70 patients who were selected via convenience sampling based on the inclusion criteria and randomly divided into two groups of intervention and placebo. The inclusion criteria were the age of ≥18 years, full consciousness (relative to place, time, and surroundings), willingness to participate in the study, ability to understand and speak Persian, and endoscopy of the gastrointestinal tract for the first time. The exclusion criteria were admission for emergency endoscopy, acute pain while completing the questionnaire, active mental and anxiety disorders, mental retardation, blindness/deafness, history of eczema and allergies to plants, history of migraine/chronic headaches, olfactory disorders, use of anti-anxiety drugs and narcotics, and history of severe psychological trauma (e.g., death of relatives) around the time of endoscopy. In the sampling, nine patients were excluded from the study (six cases patients due to eligibility based on the inclusion/exclusion criteria and three cases due to withdrawal), with the attrition rate considered 11% and new samples added by drawing lots. The study was registered in the Iranian Registry of Clinical Trials after the approval of the Ethics Committee of the Deputy of Research and Technology at Guilan University of Medical Sciences. The researcher referred to the research environment and attained the required permit. After obtaining written informed consent from the subjects, data were collected using a demographic questionnaire (age, gender, education level, marital status, occupation status, type of gastrointestinal disease, length of hospital stay, history of hospitalization, and smoking habits) and Spielberger state-trait anxiety inventory. The standard anxiety questionnaire consists of 20 items, which are scored based on a Likert scale (1=Very Low, 2=Low, 3=High, 4=Very High), and the total score of the anxiety scale is within the range of 20-80; the minimum score of 20 shows no anxiety, and the maximum score of 80 shows the highest level of anxiety. In addition, scores 21-39 indicate mild anxiety, scores 40-59 indicate moderate anxiety, and scores 60-80 indicate severe anxiety. One hour before endoscopy, the intervention group received aromatherapy with lavender essential oil, and the placebo group received aromatherapy with placebo for 30 minutes. The anxiety inventory was completed again before endoscopy. In the intervention group, two drops of 10% lavender essential oil were sprayed on a cotton ball and pinned to the collar of the patient's clothes, and the patients were asked to breathe normally for 30 minutes. In the placebo group, two drops of odorless soybean oil were used. Afterwards, the Spielberger anxiety inventory was completed again before endoscopy. Data analysis was performed in SPSS version 16 using descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (independent and paired t-test) (P<0.05).
Results: The mean age of the patients was 47.12 ± 16.75 years (age range: 18-78 years), which had no significant difference between the groups (P=0.19). The mean duration of the disease was 16.15 ± 26.84 months (range: 1-144 months). The majority of the participants were female (51.4%), married (81.4%), housewife (40%), and had an undergraduate degree (58.6%). Regarding the disease symptoms, most of the patients experienced pain (61.4%) and indigestion and heartburn (25.7%). In addition, 8.6% of the patients had smoking habits. However, no significant differences were observed between the intervention and placebo groups in terms of these variables (P<0.05). On the other hand, 45.7% of the patients reported a history of hospitalization. The results indicated that the patients had moderate anxiety in the intervention and placebo groups before and after the intervention. The mean score of anxiety before aromatherapy in the intervention group (45.91) and placebo group (50.45) was not significantly different, while after the intervention, the mean score of anxiety in the patients receiving lavender aromatherapy decreased (41.37) compared to the placebo group (49.94), indicating a significant difference in this regard (P=0.001). The results of paired t-test showed that the mean score of anxiety decreased significantly after the intervention compared to before the intervention (P<0.0001), so that after aromatherapy, the score of anxiety decreased from 45.91 to 41.37. However, the difference was not considered significant in the placebo group (P=0.110), and the mean score of anxiety reduced from 50.45 to 49.49. 
Conclusion: According to the results, aromatherapy with lavender essential oil was effective in the reduction of pre-endoscopic anxiety in the patients. Due to the reduced anxiety of the patients before endoscopy, it seems that this aromatherapy method could be used before such an invasive and stressful procedure without the unwanted side-effects of chemical drugs. Considering the cost-efficiency, safety, and simplicity of this method, aromatherapy could be used as a complementary measure to reduce anxiety in patients before endoscopy. Therefore, it is recommended that randomized controlled clinical trials with control groups be performed to compare the effects of lavender aromatherapy in with various demographic characteristics and disease-related factors (e.g., history of hospitalization in patients undergoing endoscopy).