The effectiveness of aromatherapy on stress management in nurses: a meta-analysis of randomized controlled trials

doi:10.21203/rs.3.rs-3345170/v1

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The effectiveness of aromatherapy on stress management in nurses: a meta-analysis of randomized controlled trials

https://doi.org/10.21203/rs.3.rs-3345170/v1

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Purpose: To evaluate the effectiveness of aromatherapy on stress management in nurses.

Design: Meta-analysis.

Methods: A systematic review and meta-analysis was performed following the PRISMA guidelines. We systematically searched English databases (PubMed, the Cochrane Library, Embase, and Web of Science) and Chinese databases (CNKI, CBM, Wan Fang, and VIP) for randomized controlled trials investigating the efficacy of lavender on stress in nurses. We assessed the risk of bias within studies with the revised Cochrane risk of bias tool for randomized trials. Data analysis was performed using Review Manager (version 5.4).

Results: A total of 10 RCTs with 591 nurses were included. Meta-analysis showed that aromatherapy had a significant difference for reducing nurses' stress SMD= -0.37, 95% CI (-0.53, -0.21), P=0.001) , systolic blood pressure(SMD =-4.36, 95%CI [-7.94, -0.78], P = 0.12) , and diastolic blood pressure(SMD = -3.68, 95% CI[ -6.41, -0.95], P = 0.02). No signifificant difference in heart rate was found between the aromatic group and control group (SMD = -2.15, 95% CI [-4.79, -0.49], P = 0.65).

Conclusion: The results of this meta-analysis study showed that aromatherapy can be effective at relieving nurses' stress. For more precise and dependable results, forthcoming research could allocate more significant resources toward original, high-quality investigations to further explore the effects of different types, doses, and concentrations of essential oil therapy on stress in nurses. In addition, nursing managers may consider arranging regular aromatherapy interventions for their staff to enhance their psychological regulation function, maintain their physical and mental well-being, and reduce stress levels to provide optimal medical care to patients.

Aromatherapy

nurses

stress

Meta-analysis

Stress is the mental, physical, and psychological tension that occurs when an individual faces an environment challenging to adapt to[1]. It manifests itself as symptoms of anxiety, impatience, and fatigue. Clinical nurses have higher stress levels than the general population, given the constant contact with suffering, pain, and death, increased work demands, and poor recognition of the profession[2]. However, continuous occupational stress puts nurses under chronic stress and poses a severe cumulative risk to nurses' physical and mental health[3]. It can lead to poor sleep quality, an increased risk of nursing errors[4], and an increased unemployment rate[5]. In addition, there was an increase in the number of visits and working hours due to the COVID-19 pandemic, resulting in a higher incidence of acute stress disorder among nurses[6]. Therefore, we should incorporate stress into managing disease symptoms, and managers should take steps to alleviate stress among nurses to promote their overall physical and mental well-being.

Aromatherapy is an ancient treatment method that uses the active ingredients of plants (essential oils) to treat diseases and prevent health problems[7]. Aromas can also treat physical ailments and improve mental and spiritual health through various methods, including massage, inhalation, incense, and baths[8]. It effectively relieves stress-related burnout and fatigue in nurses[9]. Aromatherapy has been claimed to improve psychological stability and affect hormones, endocrine glands, and the circulatory system[10]. Moreover, research has shown that certain essential oils used in aromatherapy possess anti-stress, antidepressant, and relaxing properties[11]. Notably, aromatherapy offers many benefits over other complementary and alternative medicines, as it is easy to deploy and does not require active patient participation, special equipment, skill expertise, or licensed specialists[12]. Hence, it has become the second most common complementary and alternative medicine method nurses accept and has been widely accepted in many countries, such as the USA and the UK [13, 14].

Many recent studies have used aromatherapy to treat nurses' stress. The results show that aromatherapy can significantly reduce nurses' stress. However, the results of these studies could be more consistent, as the methods and duration of intervention for essential oils vary. Several researchers have also indicated that insufficient data, non-randomization, and ambiguous reporting can potentially bias results[15–16]. A systematic review published in 2019[17]found that aromatherapy and massage can decrease nurses' stress levels. However, this study had several problems, including non-randomized controlled trials, non-single aromatherapy, and a need for physiological measures of stress. Additionally, numerous randomized controlled trials (RCTs) concerning aromatherapy have been published since that time.

This study analyzed related research to clarify aromatherapy's impact on nurses' stress levels. By evaluating the results, we aimed to determine the effectiveness of aromatherapy in relieving nurses' stress, thus providing them with a reliable method of stress reduction.

Design

This study has been reported according to the preferred reporting items for Systematic Reviews and Meta-analyses (PRISMA) guidelines[18], and it has been registered with the PROSPERO (No : CRD42022375315).

Search strategies

We conducted a thorough search of eight databases, including four in English (PubMed, the Cochrane Library, Embase, and Web of Science) and four in Chinese (CNKI, CBM, Wan Fang, and VIP), from their inception to Nov. 2022 without any language restrictions. In addition, we searched Google Scholar using the same text words as those used for the other databases, to locate literature not included in them and also revisited the references in the included literature to identify any additional relevant information. Finally, we evaluated the ClinicalTrials.govregistry for missing information and unpublished trials. A combination of MeSH terms and free words performed the search. The keywords and subject headings used were as follows: “Aromatherapy”, “essential oil”, “aromatic therapy”, “essence”, “aroma”, “Aromatherapies”, “Aroma Therapy”, “Aroma Therapies”, “Therapies, Aroma”, “Therapies, Aroma”, “Therapy, Aroma”, “Nurse”, “Personnel, Nursing”, “Nursing Personnel”, “Registered Nurses”, “Nurse,Registered”, “Nurses, Registered” and “Registered Nurses”. We used Boolean operators “AND” and “OR” to devise our search strategy. The developed combination of keywords and PubMed terms was then adapted to the other databases (see Supplementary file Table S1).

Inclusion and exclusion criteria

Two investigators independently screened and selected studies based on the following

inclusion criteria: (1) Participants: Nurses were included in the study sample; no restrictions were placed on nationalities, races, or genders; (2) Interventions: Any aromatherapy was employed by the experimental group. The type of essential oils used, the dosage, or the duration of the intervention were not restricted; (3) Comparisons: a control group without any treatment control or using placebo oils was used; (4)Outcomes: The primary outcome was stress, which was measured using one of the following scales: the Norwegian version of Cooper's Job Stress Questionnaire (CSQ), Work Stress Scale (WSS), Perceived Stress Scale(PSS), Nursing Stress Scale (NSS), Job Stress-Related Symptoms (JSS), Visual Analog Scale (VAS), Stress and Anxiety Subscale (DASS-42) and Park Job Stress Scale. The secondary outcome was pressure level markers; (5)Study Design: Randomized controlled trials were included without regard to language restriction.

The exclusion criteria were as follows: (1) Abstracts, case reports, guidelines, and correspondence from conferences are excluded; (2) Literature not accessible in full text or with complete data is excluded.

Risk of bias assessment

The risk of bias was evaluated using the RCT risk of bias assessment tool recommended by the Cochrane Collaboration Network[19]. The evaluation was based on the random assignment method, hidden grouping, blinding, completeness of outcome data, selective data reporting, and other sources of bias. There were three levels of bias evaluation for the raw data: “high risk of bias,” “low risk of bias” and “unknown risk of bias”. A study was scored as having a low risk of bias overall if all the critical domains were rated as low risk, unclear risk of bias overall if all the key areas were rated as low risk or unclear risk, or a high risk of bias overall if one or more key areas are rated as high risk [19]. In case of disagreement between the two evaluators, a third investigator was involved in evaluating and cross-examining the included literature.

Data extraction

Two trained evaluators independently reviewed the literature and extracted data, and a third evaluator provided input when there was disagreement. The main elements of data extraction were: author, year of publication, country, age, sample size, intervention, length of intervention, and assessment tool.

Statistical analysis

Meta-analysis was performed using RevMan 5.4 software. Considering that all outcomes in the included studies were continuous variables, 95% confidence interval (CI) mean differences (MD) or standardized mean differences (SMD) were selected. The standardized mean difference method was used when the outcome measures differed in units or had large values, and the weighted mean difference method was used in the rest of the cases[20]. If studies did not provide means or standard deviations (SD), we would calculate them according to the available data. The X² test (test level = 0.1) and the I² test were used to measure heterogeneity between the included studies' results and their size. In the case of P > 0.1 and I² = 50%, heterogeneity was acceptable, so the fixed-effects model was applied during the meta-analysis. There is evidence of heterogeneity in the presence of P = 0.1 and I² values > 50%. The source of heterogeneity must be determined. After excluding significant clinical heterogeneity, a random-effects model was utilized to conduct the meta-analysis. If there was significant clinical heterogeneity, it was analyzed through sensitivity analysis and subgroup analysis.

Search results

The PRISMA flow chart shows the detailed screening process (Fig. 1). A total of 719 citations were retrieved through database searches. After removing duplicates, 644 studies were retained. Assessed by title and abstract screening, 611 studies were excluded. Then, 33 studies were assessed for eligibility through full-text articles, a-nd 23 were excluded. Finally, we included 10 randomized controlled trials formeta-analysis.

Characteristics of the included studies

Study characteristics

Table 1 presents the characteristics of the included studies. There were 10 randomized controlled trials involving 591 participants, all from articles published after 2006. Trial sample sizes ranged from 32 to 110 individuals, and all were randomized controlled trials. Four studies were conducted in Iran[22, 23, 28, 31], two in Korea[21, 29], one in Norway[27], one in Brazil[25], one in Turkey[26], one in China[30]. The mean age of the participants ranged from 18 to 39 years.

Characteristics of aromatherapy

Most studies used a single aroma preparation, most commonly lavender oil (n = 4), as well as rose oil (n = 2) and patchouli oil (n = 1), rosemary oil (n = 1), while three studies

[25, 27, 29]used multiple aroma preparations (lavender, geranium and majolica). The dose of essential oil ranged from 2 to 5 drops, and the concentration varied from 2–100%. Aromatherapy delivery modalities included inhalation[21,22,23,24,26,28,29,

30,31], with three using gauze or cotton inhalation and three using hanging from the chest, whereas two studies[25, 27] used aromatherapy massage. The duration of each intervention ranged from 10 minutes to3 months, with eight of the studies having a duration of > 1 day. Participants in the control group received either placebo or no treatment. The placebos used included Distilled water, aliquot, Normal saline, Sunflower seed oil, and Sweet Almond Oil.

Outcome measurements

Among these included studies, the outcome assessment tools differed. In terms of primary outcomes, two studies applied the Norwegian version of Cooper's Job Stress Questionnaire(CSQ)[22, 27], two studies applied the Stress and Anxiety Subscale

(DASS-42)[28, 31], and one study applied the Work Stress Scale (WSS)[25], one study applied the Personal Information Questionnaire(PSS)[26], one study applied the Nursing Stress Scale (NSS)[23], one study applied the Job Stress-Related Symptoms(JSS)[24], one study applied the Visual Analog Scale (VAS)[21], one study applied the Park Job Stress Scale[28]. Regarding secondary Outcomes, Four studies[21, 25, 26, 29]were conducted to measure blood pressure or heart rate.

Table 1

Characteristics of included studies
Author, year	Country	Age (years)	Sample size AG CG		Intervention	Main Outcomes	Secondary Outcomes
You2020[21]	Korea	AG:26.5 ± 3.3 CG:26.4 ± 3.1	25	25	AG: two days of 5% patchouli oil inhalation were conducted CG: a 0.5mL aliquot of pure sweet almond oil was ropped onto a piece of gauze, and subjects inhaled this oil n the same manner	VAS	SBP, DBP HR
Hanieh2022[22]	Iran	AG:33.2 ± 7.4 CG:31.2 ± 4.4	30	30	AG: two drops of 40% damask rose essence were soaked incotton, and the research units were asked to place it onthe upper lip and inhale for 10 min CG: the same treatment protocol was also utilized in thecontrol group using normal saline as a placebo	CSQ	----
Zahra2021[23]	Iran	AG:29.4 ± 6.7 CG:28.7 ± 4.0	30	30	AG: each nurse with a cotton dipped in two drops of 40% rose essential oil contained in a small 10-cc container for for 90 minutes of intervention CG: cotton soaked in two drops of distilled water was given to each subject. The nurses were then asked to inhale it for 10 minutes at a distance of 5 cm	NSS	----
Ghods2017[24]	China	AG:33.0 ± 6.7 CG:33.2 ± 6.4	53	57	AG: the nurses in the experimental group hung a bottle of 3% lavender oil on their right breast for four consecutive days. CG: the nurses in the control group wore bottles without lavender oil on their right breast for four consecutive days		----
Mgqn2017[25]	Brazil	A:39.5 ± 9.8	19	19	AG: the intervention consisted of six neutral cream massage sessions with average duration of 10 to 15 minutes, and average interval of 42 hours between sessions CG: None	WSS	HR
Nadiye2017[26]	Turkey	:A:25.8 ± 5.2	28	17	AG: Add 5 drops of lavender oil to your robe for 3 months. CG: Add 5 drops of sunflower seed oil to your robe for 3 months	PSS	SBP, DBP HR
Hansen2006[27]	Norway	A:25–63	18	14	AG: The treatment included a full-body massage with each session lasting 90 min. CG: None	CSQ	----
Hossein2019[28]	Iran	A:20–36	39	39	AG: The 25% essential oils of rosemary were applied from 8 to 10 O’clock (2 hour) at 3 shifts per week for one month CG: The Sweet Almond Oil were applied from 8 to 10 O’clock (2 hour) at 3 shifts per week for one month	DASS	----
Jeong2010[29]	Korea	A:18–30	25	23	AG: Inhalation of 0.2 ml of essential oil mixture for 5 days CG: None	PJSS	SBP, DBP HR
Alavi2015[31]	Iran	AG:30.0 ± 4.01	35	35	AG: Inhalation of lavender essential oil for 4 days CG: None	DASS	----
Note: AG: Aromatherapy group; CG: Control group; A:All; ----:None.
VAS:Visual Analog Scale; CSQ: the Norwegian version of Cooper's Job Stress Questionnaire; NSS:Nursing Stress Scale; JSS:Job Stress-Related Symptoms; WSS: Work Stress Scale; PSS: Perceived Stress Scale; DASS: Stress and Anxiety Subscale; PJSS:Park Job Stress Scale;

SBP:Systolic blood pressure; DBP:Diastolic blood pressure; HR:Heart rate.

Quality assessment of included studies

Figure 2 present the results of the critical appraisal. Based on the judgment of the risk of bias for the seven items, one[27]study was rated as having a high overall risk of bias, and nine studies were rated as having an unclear overall risk of bias.

Regarding random sequence generation, six studies[21, 22, 23, 26, 27, 29]describe specific methods for random assignment. Of these, four[21, 22, 29]reported the random number table method, two[26, 27]reported the lottery method, and one [23]reported the coin toss method. Regarding allocation concealment, three studies[21, 22, 26]used sequentially numbered opaque envelopes, and seven studies did not provide information on allocation concealment. Due to the nature of aromatherapy, blinding partcipants and assessing outcomes adequately is difficult. Regarding blinding of participants and personnel, there was only one[21]blinding for participants and research nurses in four studies, and patients in this study were unaware of the type of essential oil inhaled to avoid any placebo effect. Regarding blinding of outcome assessment, only one[23]study blinded the outcome assessors to the participant’s group allocation. All included studies had low attrition bias and reporting bias, as no evidence of incomplete outcome data and selective reporting was found. Another risk of bias was judged to be high in one [27] study due to the imbalance in baseline characteristics between the experimental and control groups.

Meta-analysis results

Effect of aromatherapy on stress

The meta-analysis evaluated 10 studies, including 302 aromatherapy patients and 289 control patients, to assess how effective aromatherapy is at relieving nurses' stress. In the meta-analysis, no significant heterogeneity was identified between the included randomized controlled trials (p = 0.60, I² = 0%), and fixed effects were selected. In summary, the aromatherapy group differed statistically from the control group in overall stress scores [SMD= -0.37, 95% CI (-0.54, -0.21), P = 0.00001], suggesting that aromatherapy can relieve nurses' stress compared with control group (Fig. 3).

The subgroup analyses were based on aromatherapy inhalation and aromatherapy massage. The meta-analysis of aromatherapy on stress management in nurses included 8 studies with an aromatic group of 265 and 256 cases in a control group. Statistically significant differences were found between the two groups (SMD= -0.34, 95%CI[-0.52,-0.17], P = 0.001). The studies were no significant no significant heterogeneity (P = 0.49, I² = 0%). The other 2 studies were aromatherapy massages, including 37cases in the aromatherapy group and 33 cases in the control group. A statistically insignificant difference between the two groups was found (SMD=-0.59, 95%CI [-1.07, -0.11], P = 0.02). The two subgroups were not significantly different P = 0.67, I² = 0%). The results of the subgroup analyses see supplementary file Fig. S1.

Effect of aromatherapy on blood pressure

The meta-analysis of aromatherapy's effect on blood pressure included 3 studies with 89 cases in both the aromatherapy and control groups. A statistically significant difference in systolic blood pressure was found between the two groups (SMD=-4.36, 95%CI[-7.94, -0.78], P = 0.02), with moderate heterogeneity between the research studies(P = 0.12, I² = 53%). A statistically significant difference was noted in diastolic blood pressure between the two groups (SMD=-3.68, 95%CI[-6.41, -0.95], P = 0.008), with significant heterogeneity between studies(P = 0.02, I² = 73%). (Fig. 4)

Effect of aromatherapy on heart rate

An analysis of 4 studies on the effects of aromatherapy on heart rate included108 cases from both experimental and control groups. It was not statistically significant that the two groups had different heart rates(SMD=-2.15, 95%CI[-4.79,-0.49], P = 0.11), nor was there significant heterogeneity(P = 0.65, I² = 0%). (Fig. 5)

Publication bias

RevMan 5.3 software was used to evaluate the efficacy of aromatherapy, and publication bias was taken into account. The results showed that the 10 randomized controlled trials included were relatively symmetrical in distribution on both sides of the funnel plot and had a slight publication bias. The results of the subgroup analyses see supplementary file Fig. S2.

This study included 10 randomized controlled trials, and the meta-analysis results showed that compared with non-aromatherapy, aromatherapy reduced nurses' stress and had some effect on blood pressure reduction. Furthermore, claims that aromatherapy lowers blood pressure should be cautiously treated due to the few included studies. Stress can increase depression and anxiety, reduce job satisfaction, damage personal relationships, and even lead to suicidal thoughts. Moreover, work stress adversely impacts physical and psychological health. Work or work-related stress is undoubtedly one of the leading causes of mental health problems worldwide. In addition to impairing employees' performance, high-stress levels adversely affect their behavior and attitudes [31, 32]. According to a national study of 130 occupations by the National Institutes of Health (NIH), nurses ranked 27th for mental health problems. It was determined in the same survey that 7.4% of nursing staff were absent each week as a result of emotional fatigue and stress, which is a more significant percentage than 80% of other professionals [33]. According to a systematic review and meta-analysis, most front line healthcare workers who care for COVID-19 patients experience stress, anxiety, and depression[34]. Moreover, the studies included in this study were primarily conducted by nurses in particular departments, such as emergency departments and intensive care units. Studies have shown a high risk of infections and stress among medical staff in emergency departments and intensive care units [35]. On the other hand, aromatherapy has been shown to reduce stress in nurses [13]. It means essential oils may reduce stress through non-overlapping molecular pathways. Meanwhile, aromatherapy is non-invasive, easily accessible, has low side effects [36], and has no adverse effects. Our study shows that aromatherapy relieves stress for nurses. Therefore, aromatherapy is a safe and non-pharmacological treatment, and nurses can use this method to increase their workplace comfort. And can reduce nurses' overreliance on medications to relieve work-related stress.

Our research has shown that aromatherapy inhalation and aromatherapy massage are the main routes of delivery of essential oils, and both were effective at relieving nurses' stress. This result is consistent with Hung's [37] studies. Aromatic inhalation has the following mechanism. By inhaling essential oil molecules, important oil molecules are transmitted to the brain's limbic system by the nasal cavity's olfactory bulb cells and through nerve conduction. The brain is stimulated to secrete neurotransmitters such as serotonin and dopamine, which can control the nervous system in both directions, beneficial to regulating mood. In addition, aromatic massage is used to relax the body and mind by bringing the active ingredients of essential oils into the blood circulation through the skin and mucous membranes [9]. In the subgroup of intervention modalities, aromatic massage reduced stress more effectively than inhalation aromatherapy. However, the aromatic massage group had too small a sample size to draw conclusions. When using massage aromatherapy, small amounts of essential oils are inhaled into the body in addition to the massage session[38]. Aromatic massage's mechanisms include the stimulating effect of essential oils on the olfactory system and massage. So it is challenging to distinguish which function is primary.

Aromatherapy often involves inhaling essential oils for their therapeutic benefits. It affects blood pressure (BP) and heart rate (HR) through autonomic circulation control. We found that aromatherapy has a different effect on blood pressure but not on heart rate. However, more studies were needed in this study to obtain convincing results. Aromatherapy reduces blood pressure by activating the parasympathetic nervous system and decreasing the sympathetic nervous system. In our study, there was a high level of heterogeneity. It may be due to the different ways and duration of aromatherapy used in these studies. In future studies, it is necessary to compare the most effective application method, frequency, and aromatherapy time.

However, there was no difference in aromatherapy's effect on heart rate. This study's results agree with Hung et al[39]. There are several possible explanations. Firstly, the baseline heart rates of the participants included in the study were average, so the effect of aromatherapy was not significant. Secondly, heart rate can vary instantaneously based on environmental factors or time of day, stabilizing errors caused by time or method of measurement inaccuracies. Finally, there is also a wide range of physiological responses between individuals. Therefore the direct stimulatory effect of aroma did not reduce heart rate. In contrast, Wu et al [40] showed that aromatherapy massage relieved HR. These conflicting results can be explained by the duration of the physiological indicators tested. Some studies have shown that aromatherapy duration affects physiology and that short cycles are favorable [25]. The interventions we included had durations of 2 days, 5 days, and 2 months, leading to unpredictable results. It is necessary to conduct further research to understand the reasons for these findings.

In addition, among the studies included in this study, the results of one [23] literature study showed no positive effect of aromatherapy on reducing nurses' stress. This study used 25% rosemary essential oil, requiring nurses to inhale it 3 times a week for 2 hours for one month. This study used a different type of essential oil, concentration, and assessment tool than other studies. It is vital to consider the type, dose, and concentration of essential oils, as well as the assessment tools used, as they all play a role in the effectiveness of the intervention. Further research should explore the effects of different essential oil types, doses, and concentrations, as well as various assessment tools, on reducing stress in nurses. In the meantime, future studies should utilize reliable and validated tools to study aromatherapy's effects on nurse's subjective stress. Furthermore, they should examine the impact of aromatherapy on nurses' stress in terms of physiological indicators.

Strengths and limitations

This meta-analysis had two strengths: (a) The included studies are from very diverse countries, reflecting studies of various cultures. Therefore, this study can provide universal knowledge that is applicable worldwide. (b) with only the RCTs included in this meta-analysis, there was an enhancement in the methodological quality of the study. However, the present study also had two limitations: (a) The small number of included studies and small sample size in this study may affect the accuracy of the results, and it is recommended that large samples and randomized controlled trials are needed in the future. (b) The literature included in this study was not completely consistent regarding intervention length and intervention measures, which may affect the stability of the results, and future studies should control the duration and measures of interventions.

The findings of this meta-analysis study indicate that aromatherapy can alleviate stress among nurses. For more precise and dependable results, forthcoming research could allocate more significant resources toward original, high-quality investigations to further explore the effects of different types, doses, and concentrations of essential oil therapy on stress in nurses. In addition, nursing managers may consider arranging regular aromatherapy interventions for their staff to enhance their psychological regulation function, maintain their physical and mental well-being, and reduce stress levels to provide optimal medical care to patients.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Data Availability

All data generated or analyzed during this study is included in this published article.

Competing interests

No conflict of interest exists in the submission of this manuscript.

Funding

None

Author Contributions

MCW drafted this manuscript; JZL provided significant contributions to the conception and design; HZ, MCW and XLZ all contributed significantly to the conceptualization and design of the review, as well as the collection, analysis, and interpretation of the data; JZL critically revised the essay for intellectual substance; JZL approved the final version of the article to be published. The final manuscript was read and approved by all authors.

Acknowledgements

We would like to thank the teachers and classmates who helped us with the technical issues during the research process, as well as all the authors we included in the study.

Schneiderman N, Ironson G, Siegel SD. Stress and health: psychological, behavioral, and biological determinants. Annu Rev Clin Psychol. 2005;1:607-28. https://doi.org/10.1146/annurev.clinpsy.1.102803.144141.
Chen C, Meier ST. Burnout and depression in nurses: A systematic review and meta-analysi Int J Nurs Stud. 2021;124:104099. https://doi.org/10.1016/j.ijnurstu.2021.104099.
Weigl T, Tölle AS, Seppelfrick T. Differential aspects of chronic work-related stress predict depression in registered and geriatric nurses. Pflege. 2021;34(3):133-140. https://doi.org/10.1024/1012-5302/a000802.
Stanojevic C, Simic S, Milutinovic D. Health effects of sleep deprivation in nurses working shifts[J]. Med Pregl. 2016;69(5-6):183-188. https://doi.org/10.1186/s12912-023-01257-1.
Lee E, Jang I. Nurses' Fatigue, Job Stress, Organizational Culture, and Turnover Intention: A Culture-Work-Health Model. West J Nurs Res. 2020;42(2):108-116. https://doi.org/10.1177/0193945919839189.
Sun F, Wang A, Xue J, et al. The mediating effect of psychological capital on the relationship between psychological stress and distress among Chinese nursing students: a cross-sectional study. BMC Nurs. 2022;21(1):128. https://doi.org/10.1186/s12912-022-00915-0.
Gnatta JR, Kurebayashi LF, Turrini RN, et al. Aromatherapy and nursing: historical and theoretical conception. Rev Esc Enferm USP. 2016;50(1):130-6. Portuguese. https://doi.org/10.1590/S0080-623420160000100017.
Puvača N, Milenković J, Galonja T, et al. Antimicrobial Activity of Selected Essential Oils against Selected Pathogenic Bacteria: In Vitro Study. Antibiotics (Basel). 2021;10(5):546. https://doi.org/10.3390/antibiotics10050546.
CHO HJ, KWON KH. Prior Literature Analysis: The Reduction of Employee Perceived Stress through Aromatherapy. The Journal of Industrial Distribution & Business [Internet]. 2022;13(7):7–16. Available from: https://doi.org/10.13106/JIDB.2022.VOL13.NO7.7.
Ali B, Al-Wabel NA, Shams S, et al. Essential oils used in aromatherapy: A systematic review. Asian Pacific Journal of Tropical Biomedicine. 2015;5(8): 601-611. https://doi.org/10.1016/j.apjtb.2015.05.007.
Go GY, Park H. Effects of aroma inhalation therapy on stress, anxiety, depression, and the autonomic nervous system in high-risk pregnant women. Korean Journal of Women Health Nursing. 2017;23(1): 33-41. https://10.4069/KJWHN.2017.23.1.33.
Fayazi S, Babashahi M, Rezaei M. The effect of inhalation aromatherapy on anxiety level of the patients in preoperative period. Iran J Nurs Midwifery Res. 2011;16(4):278-83.
Johnson K, West T, Diana S, et al. Use of aromatherapy to promote a therapeutic nurse Intensive Crit Care Nurs. 2017;40:18-25. https://doi.org/10.1016/j.iccn.2017.01.006
Long L, Huntley A, Ernst E. Which complementary and alternative therapies benefit which conditions? A survey of the opinions of 223 professional organizations. Complement Ther Med. 2001;9(3):178-85. https://doi.org/10.1054/ctim.2001.0453.
Guo P, Li P, Zhang X, et al. The effectiveness of aromatherapy on preoperative anxiety in adults: A systematic review and meta-analysis of randomized controlled trials. International Journal of Nursing Studies.2020;111:103747. https://doi.org/10.1016/j.ijnurstu.2020.103747.
Wynne B, McHugh L, Gao W, et al. Acceptance and Commitment Therapy Reduces Psychological Stress in Patients With Inflammatory Bowel Diseases. Gastroenterology. 2019;156(4):935-945.e1. https://doi.org/10.1053/j.gastro.2018.11.030.
Li H, Zhao M, Shi Y, et al. The effectiveness of aromatherapy and massage on stressmanagement in nurses: A systematic review. JClin Nurs. 2019;28(3-4):372-385.. https://doi.org/10.1111/jocn.14596.
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updatedguideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71.
Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised BMJ. 2011;343:d5928. https://doi.org/10.1136/bmj.d5928.
DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986:7:177-88. https://doi.org/10.1016/0197-2456(86)90046-2.
You KS, Lee SY, Lee JM, et al. Effects of Short-Term Inhalation of Patchouli Oilon Prof essional Quality of Life and Stress Levels in Emergency Nurses: A Randomized Controlled Trial. Journal of alternative and complementary medicine. 2020, 26(11). https://doi.org/10.89/acm.2020.0206.

Hanieh B, Meysam HA, Hossein S et al.The Effect of Aromatherapy with Damask Rose on Anxiety, Accuracy and Job Stress in Operating Room Nurses.Evidence Based Care Journal.2022;12(1):56-62. https://civilica.com/doc/123625
Farsi Z, Rajai N, Teymouri F, et al. Effect of Aromatherapy with Rosa Damascena Essential Oil on Nurses' Occupational Stress in the Emergency Department: A Randomized Controlled Trial. Preventive Carein Nursing & Midwifery Journal. 2021;3:46–54. https://doi.org/10.52547/pcnm.11.3.46.
Chen MC, Fang SH, Fang L. The effects of aromatherapy in relieving symptoms related to job stress among nurses. Int J Nurs Pract. 2015;2121(1):87-93. https://doi.org/10.1111/ijn.12229.

Montibeler J, Domingos TDS, Braga EM, et al. Effectiveness of aromatherapy massage on the stress of the surgical center nursing team: a pilot study. Rev Esc Enferm USP. 2018;52:03348. Portuguese, English. https://doi.org/10.1590/S1980-220X2017038303348.
Eren NB, Oztunc G. The effects of aromatherapy on the stress and anxiety levels of nurses working in intensive care units[J]. Int J Care Sci, 2017, 10(3): 1615-23.
Hansen TM, Hansen B, Ringdal GI. Does aromatherapy massage reduce job-related stress? Results froma randomised, controlled trial[J].International Journal of Aromatherapy. 2006;16(2):89-94. https://doi.org/10.1016/j.ijat.2006.04.004.
Rahimi H, Nakhaei M, Mehrpooya N, et al. The effect of inhaling the aroma of rosemary essential oilon the pre-hospital emergency personnel stress and anxiety: A quasi-experimental study[J]. Modern Care Journal, 2019, 16(3). https://doi.org5812/MODERNC.9508
Jo MJ. The effects of aroma inhalation on stress, fatigue, mood, and vital signs of the nurses in the operating rooms. Journal of Korean Academy of Adult Nursing. 2010:153-160.
Alavi M, Farokhnezhad P, Daneshvar S. The effect of Lavender essence on stress in intensive care unit (ICU) nurses[J]. Iranian Journal of Cardiovascular Nursing, 2015, 4(1): 6-12.
Lloyd A, Fiala D, Heyde C et al. A mathematical model for predicting cardiovascularresponses at rest and during exercise in demanding environmental conditions. Journal of applied physiology. 2022;133(2),247–261. https://doi.org/10.1152/japplphysiol.00619.2021.
Babapour, AR, Gahassab-Mozaffari N, Fathnezhad-Kazemi Nurses’ job stress and itsimpact on quality of life and caring behaviors: a cross-sectional study. BMC Nurs. 2022;21(1):75. https://doi.org/10.1186/s12912-022-00852-y.
Noorbala A, Mohammad K, Bagheri Yazdi SA, et al. Study of mental health status of individuals above 15 years of age in Islamic Republic of Iran in the year 1999[J]. Hakim Research Journal. 2002;5(1):1-10. https://sid.ir/paper/29374/en.
Salari N, Khazaie H, Hosseinian-Far A, et al. The prevalence of stress, anxiety and depression withinfront-line healthcare workers caring for COVID-19 patients: a systematic review and meta-regression. Human resources for health.2020;18(1):100. https://doi.org/10.1186/s12960-020-00544-1.
Gualano MR, Sinigaglia T, Lo G, et al. The Burden of Burnout among Healthcare Professionals of Intensive Care Units and Emergency Departments during the COVID-19 Pandemic: ASystematic Review.IntJ Environ ResPublic Health. 2021;18(15):8172. https://doi.org/10.3390/ijerph18158172.
Wen X, Shi J, Tan W, et al. Effects of aromatherapy and music therapy on patients' anxiety during MRI examinations: a randomized controlled trial. Eur Radiol. 2023;33(4):2510-2518. https://doi.org/10.1007/s00330-022-09230-3.
Emadikhalaf M, Ghods AA, Sotodeh-Asl N, et al. Effects of rose and lavender scentson nurses' job stress: A randomized controlled trial. Explore (NY). 2023:9(3),371–375.https://doi.org/10.1016/j.explore.2023.01.002.
Seyyed-Rasooli A, Salehi F, Mohammadpoorasl A, et al. Comparing the effects of aromatherapy massage and inhalation aromatherapy on anxiety and pain in burn patients:A single-blind randomized clinical trial. Burns. 2016;42(8):1774-1780. https://doi.org/10.1016/j.burns.2016.06.014.
Hung CL, Lin YL, Chou CM, et al. Efficacy of Aromatherapy at Relieving the Work-Related Stress ofNursing Staff from Various Hospital Departments during COVID-19.Healthcare (Basel). 2023;11(2):157. https://doi.org/10.3390/healthcare11020157.
Wu CY, Lee HF, Chang CW, et al. The Immediate Effects of Lavender Aromatherapy Massage versus Massage in Work Stress, Burnout, and HRV Parameters: A Randomized Controlled Trial. Evid Based Complement Alternat Med. 2020;2020:8830083. https://doi.org/10.1155/2020/8830083.

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The effectiveness of aromatherapy on stress management in nurses: a meta-analysis of randomized controlled trials

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Abstract

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Introduction

Methods

Design

Search strategies

Inclusion and exclusion criteria

Risk of bias assessment

Data extraction

Statistical analysis

Result

Search results

Characteristics of the included studies

Study characteristics

Characteristics of aromatherapy

Outcome measurements

Quality assessment of included studies

Meta-analysis results

Effect of aromatherapy on stress

Effect of aromatherapy on blood pressure

Effect of aromatherapy on heart rate

Publication bias

Discussion

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Conclusion

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