Best Practice| Volume 38, ISSUE 2, P206-212, April 2023

Implementation of Aromatherapy, a Nonpharmacological Intervention, to Reduce Anxiety During the Preoperative Period

Published:February 01, 2023DOI:



      The purpose of the project was to answer the following question: Does the implementation of aromatherapy before surgery reduce preoperative anxiety in adult surgical patients undergoing elective surgery?


      This evidence-based project was a quality improvement initiative that used pre- and poststate anxiety evaluations to determine the effect of aromatherapy on preoperative anxiety among adults undergoing elective surgery.


      The project team conducted a literature review to evaluate the appropriateness of using aromatherapy to decrease preoperative anxiety. The team delivered pre- and postaromatherapy State Trait Anxiety Inventory for Adults (STAIAD) Short form Y-1 questionnaire and administered an aromatherapy diffuser clip comprised of three evidence-based scented oils to determine the effect of aromatherapy on preoperative anxiety among adults undergoing elective surgery.


      Pre- and postaromatherapy (STAIAD) Short Form Y-1 questionnaires indicated that exposure to aromatherapy significantly reduced preoperative anxiety. There was a statistically and clinically significant difference in state anxiety score after aromatherapy exposure, with a mean state change of 17.42 points (P < .001). This exceeded the effect size benchmark derived from the evidence, which defined a significant change in state score as 5 points. Participants above the median age exhibited the most profound decrease in anxiety regardless of gender. Qualitative survey responses indicated that 96% of patients would use preoperative aromatherapy in the future and 91% experienced increased satisfaction with their perioperative care.


      Heightened physiological response to increased anxiety leads to increased perioperative nausea and vomiting, higher pain scores, and susceptibility to prolonged recovery from surgery. Implementing aromatherapy can reduce anxiety, thereby attenuating these complications and preventing additional accrued cost. Furthermore, this evidence-based project has the added benefit of increasing overall patient satisfaction with the perioperative process.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of PeriAnesthesia Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Jaruzel CB
        • Gregoski M
        • Mueller M
        • Faircloth A
        • Kelechi T
        Aromatherapy for preoperative anxiety: a pilot study.
        Am Soc PeriAnesthesia Nurs. 2018; 34: 1-6
        • Bopp EJ
        • Spence DL
        • Burkard JF
        A preoperative stress inquiry and a vulnerable United States military population.
        J PeriAnesthesia Nurs. 2013; 28: 67-76
        • Wotman M
        • Levinger J
        • Leung L
        • Kallush A
        • Mauer E
        • Kacker A
        The efficacy of lavender aromatherapy in reducing preoperative anxiety in ambulatory surgery patients undergoing procedures in general otolaryngology.
        Laryngoscope Investig Otolaryngol. 2017; 2: 437-441
      1. The Defense Health Agency. DoD Agency Strategic Plan [Strategy map]. 2017. Accessed July 15, 2018.

        • Braden R
        • Reichow S
        • Halm MA
        The use of the essential oil lavandin to reduce preoperative anxiety in surgical patients.
        J PeriAnesthesia Nurs. 2009; 24: 348-355
        • Wasden ML
        High reliability principles must be tied to value-based outcomes.
        Front Health Serv Manage. 2017; 33: 26-32
        • Military Health System
        Navy Medical Center San Diego.
        2018 (Updated January 15. Accessed July 28, 2018.)
        • Fayazi S
        • Babashahi M
        • Rezaei M
        The effect of inhalation aromatherapy on anxiety level of the patients in preoperative period.
        Iranian J Nurs Midwifery Res. 2011; 16: 278-283
      2. Soothing Scents. (2019). Retrieved from Spielberger, C.D. (2015). State trait anxiety inventory for adults: Forms Y-1 and Y-2 manual. Palo Alto, CA: Mind Garden, Inc.

        • Sackett DL
        • Straus SE
        • Richardson WS
        • Rosenberg W
        • Haynes RB
        Evidence-Based Medicine: How to Practice and Teach EBM.
        2nd ed. Churchill-Livingstone, New York2000
        • Titler MG
        • Kleiber C
        • Steelman VJ
        • Budreau G
        • Buckwalter CK
        • Goode CJ
        The IOWA model of evidence-based practice to promote quality care.
        Crit Care Nurs Clin N Am. 2001; 13: 497-509
        • Eslami J
        • Ebrahimi A
        • Hosseinkhani A
        • Khazaei Z
        • Darvishi I
        The effect of aromatherapy using lavender and citrus extracts to treat anxiety of patients undergoing laparoscopic cholecystectomy: a randomized clinical trial in Iran.
        Biomed Res Ther. 2018; 5: 2096-2110
        • Doody M
        • Dood
        Introducing evidence into nursing practice: using the IOWA model.
        Br J Nurs Open. 2011; 20: 661-664
      3. Food and Drug Administration. (2020). Face masks and surgical masks for COVID-19. Accessed March 10, 2020.

        • Chapman CR
        • Cox GB
        Determinants of Anxiety in Elective Surgery Patients. Stress and Anxiety, 4.
        Wiley, Washington, D.C.1977
        • Food and Drug Administration
        Face Masks and Surgical Masks for COVID-19.
        (May 11)2020
        • Spielberger CD
        State Trait Anxiety Inventory for Adults: Forms Y-1 and Y-2 Manual.
        Mind Garden, Inc, Palo Alto, CA2015
        • Doyle C
        • Lennox L
        • Bell D
        A systematic review of evidence on the links between patient experience and clinical safety and effectiveness.
        Br Med J Open. 2013; 3: 1-16
        • Kellermann A
        Rethinking the United States military healthcare system.
        Health Affairs. 2017; (Accessed June 8, 2018)
      4. Ellison A. Average hospital expenses per inpatient day across 50 states. 2019. Accessed June 8, 2018.