See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/333749511

The Effect of Aromatherapy on Fatigue and Anxiety in Patients

Undergoing Hemodialysis Treatment: A Randomized Controlled Study

Article in Holistic Nursing Practice · July 2019

DOI: 10.1097/HNP.0000000000000334

CITATIONS READS

40 2,041

2 authors, including:

Sevgin Samancioglu Baglama

Mugla Üniversitesi
32 PUBLICATIONS 324 CITATIONS

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Use of an effective compound in the management of hyperglycemia View project

Complementary Therapy: Reflexology in Patient with Romatoid Arthritis View project

All content following this page was uploaded by Sevgin Samancioglu Baglama on 03 July 2019.

The user has requested enhancement of the downloaded file.

 F E AT U R E S

The Effect of Aromatherapy on Fatigue and

Anxiety in Patients Undergoing Hemodialysis
Treatment
A Randomized Controlled Study
Downloaded from https://journals.lww.com/hnpjournal by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3z484KQalTVETncwKJTq3oJxLHZ+LuV6HAyFrsmNke9Hswkmm3reVuw== on 06/18/2019

■ Ezgi Karadag, PhD, RN ■ Sevgin Samancioglu Baglama, PhD, RN

The aim of this study was to examine the effect of the application of lavender oil on fatigue and anxiety levels in
patients undergoing hemodialysis treatment. This randomized controlled study was conducted with 60 patients
(30 patients in intervention group, 30 patients in control group) in a province located in southeastern Turkey. After
the patients in both groups were informed about the study, a questionnaire, the Fatigue Severity Scale, and the
Beck Anxiety Inventory were applied to the patients. In the intervention group, a statistically significant difference
was found between pretest and posttest scores of the Fatigue Severity Scale (t = 7.177, P = .001) and the Beck
Anxiety Inventory (t = 10.371, P = .001). Mean scores of fatigue and anxiety decreased significantly following
aromatherapy and also fatigue and anxiety levels declined. Lavender aromatherapy can be applied as an effective
nursing intervention to reduce fatigue and anxiety of patients with chronic renal failure and undergoing
hemodialysis treatment. KEY WORDS: anxiety, aromatherapy, fatigue, hemodialysis Holist Nurs Pract 2019;33(4):222–229

INTRODUCTION Nephrology, total number of patients undergoing

Being an important public health problem in the world
and in Turkey, end-stage renal disease (ESRD) is a
chronic condition that develops because of numerous
causes, resulting in loss of renal functions and uremic
syndrome, and requiring irreversible complex
treatments and high economic expenses.1 End-stage
renal disease requires lifelong dialysis or kidney
transplantation.2 The number of patients with ESRD
worldwide is estimated to increase by about 30% by
2050.3,4 Hemodialysis is the most common treatment
for ESRD among treatment methods.5 According to
the 2016 records of the Turkish Society of
Author Affiliations: Faculty of Nursing, Dokuz Eylul University, Inci-
ralti, Izmir, Turkey (Dr Karadag); and Health Science Faculty, Gaziantep
University, Gaziantep, Turkey (Dr Baglama).
The authors thank all of the patients who willingly contributed to this re-
search. Also, they thank the nurses of the hemodialysis wards who cooper-
ated with them in conducting the study.
The authors have no conflict of interest to declare.
Correspondence: Ezgi Karadag, PhD, RN, Department of Oncology Nurs-
ing, Faculty of Nursing, Dokuz Eylul University, 35340 Inciralti/Izmir,
Turkey (ezgikaradag44@gmail.com).
DOI: 10.1097/HNP.0000000000000334
hemodialysis have increased to 56.687 in Turkey.5
In patients with ESRD, their quality of life is
affected adversely because of both negative effects of
the disease on systems and the biopsychophysiological
effects of hemodialysis treatment. Although
hemodialysis treatment saves lives of patients, this
treatment considerably limits normal lifestyle and
quality of life. Patients face problems such as
becoming dependent on the machine and treatment
team on certain days of week, medication and diet
therapy, changes in working life, role changes in
family, economic difficulties, sexual dysfunctions,
limitations in social life, and worry for maintaining
life. These conditions generally cause feelings of
anxiety, anger, rebellion, and hopelessness in patients.
As these feelings increase, patients experience mental
problems such as denial, negativism, refusal of
treatment or difficulty in compliance, fear of death,
anxiety, and depression along with fatigue.6,7
Fatigue is one of the most frequent and important
problems considerably affecting quality of life in
patients with ESRD. Fatigue is described as an
unpleasant condition such as listlessness, weakness,
burnout, and energy deficiency associated with

222

Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.

long-lasting stress. Fatigue is also defined as an
unpleasant and subjective symptom with a degree of
fatigue that may vary from exhaustion to burnout and
may influence and diminish the normal functions and
roles of individuals.8 Prevalence of fatigue ranges
from 60% to 97% in patients undergoing renal
replacement treatments for a long time.9 In the
literature, it is indicated that physical functions of
patients undergoing hemodialysis are lower than
physical functions of patients with other chronic
disease, and fatigue and low energy are the most
distressing symptoms in patients undergoing
hemodialysis as well.8 Fatigue (74%), anxiety (38%),
and depression (28%) are the leading among the most
prevalent symptoms of patients undergoing
hemodialysis.1 Fatigue is a stressful condition and
hemodialysis patients may have difficulty in coping
with fatigue. Patients suffering from fatigue become
obliged to show more effort to realize physical and
cognitive activities, which also may lead to increased
anxiety. Anxiety levels of patients having fatigue
problem increases or patients experience fatigue due
to anxiety; in other words, fatigue and anxiety
mutually influence each other. Untreated fatigue of
patients undergoing hemodialysis may cause
weakness, physical and psychological energy loss,
social isolation, and depression.10 Therefore,
interventions aiming at eliminating or decreasing
fatigue may decrease anxiety, as well.
Fatigue of hemodialysis patients is treated with
pharmacological and nonpharmacological methods.
Agents used in pharmacological treatment are
cause-oriented and reports indicate that they cannot
control fatigue effectively and at the desired level.11
For this reason, nonpharmacological methods, which
are safer and have less side effects than
pharmacological methods, are used. Studies report
that patients undergoing hemodialysis use
complementary practices such as acupressure,
acupuncture, homeopathy, exercise, yoga, reflexology,
and aromatherapy to cope with symptoms such as
fatigue, pain, cramps, anxiety, depression, and sleep
disorders, and to enhance their quality of life.11,12
Aromatherapy, one of the complementary practices
used for fatigue and anxiety problems of patients
undergoing hemodialysis, is defined as the use of
essential oils, which are extracted from herbal
resources (leaves, flowers, barks, fruits, and roots) and
are concentrated, for their therapeutic effects.13,14
Essential oils used in aromatherapy are reported to
have numerous effects such as relaxation,
Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Effect of Aromatherapy on Fatigue and Anxiety 223
anti-inflammatory, analgesic, disinfection, antioxidant,
and low blood urea level.12-14 It is also highlighted that
these aromatic oils applied particularly via inhalation
have refreshing and concentration-increasing effects
by being absorbed in blood and lungs through the nose
and influence mental and physical stability. Sense of
smell activates the limbic system and hormones,
which may decrease depression, stress, and chronic
fatigue by increasing emotional response.15-17
It is suggested that lavender oil, which is commonly
used in aromatherapy, is effective on amygdale, has a
relieving and sedative effect, relaxes smooth muscles,
positively influences the quality of sleep due to these
characteristics, has antibacterial, antifungal,
antidepressant, and anxiety and stress-reducing
characteristics, and is also the least toxic and allergic
among the all aromatic oils.18,19 In the study
conducted by Muz and Taşçı20 on patients undergoing
hemodialysis treatment, they stated that aromatherapy
with lavender oil applied through inhalation decreased
the level and severity of fatigue. Karaman et al21
found that aromatherapy with lavender oil positively
influenced anxiety level during needle cannulation
among patients undergoing hemodialysis.
Despite the fact that especially nurses in Turkey
have the competence to use several complementary
practices for protecting and promoting health, they are
not able to integrate these practices into care. It is
important for nurses who interact with patient for the
longest time among the health care team to be aware
of problems of patients and to produce evidence-based
solutions for these problems. Therefore, this study is
intended to produce evidence-based data for nurses in
Turkey to apply independent nursing interventions. In
addition, there is a limited number of studies
evaluating the effect of lavender oil on fatigue and
anxiety in patients undergoing hemodialysis in Turkey;
therefore, this study is important in terms of revealing
the need. The aim of this study was to examine the
effect of lavender oil on fatigue and anxiety levels in
patients undergoing hemodialysis treatment.
The hypotheses of the study
H1. There is a significant difference between pretest-
posttest mean scores of the fatigue scale in patients
inhaling lavender oil.
H2. There is a significant difference between pretest-
posttest mean scores of the Beck Anxiety Inventory
(BAI) in patients inhaling lavender oil.
224 HOLISTIC NURSING PRACTICE • JULY/AUGUST 2019
METHODS
Study design
This study was designed as a randomized controlled
trial.
Setting and sampling
The population of the study consisted of patients
receiving treatment in the hemodialysis unit of
Gaziantep University Şahinbey Research and
Application Hospital located in a province in
southeastern Turkey between March and December
2017.
The sample size of this study was calculated by
using power analysis in G-power statistical software.
It was determined that 30 aromatherapy cases and 30
control cases were needed at significance level of .05
(α), statistical power (1 − β) of .80, and effect size of
0.74 calculated in previous studies.11 Sixty patients (30
patients in intervention group and 30 patients in control
group), who received treatment in the hemodialysis
unit and met the inclusion criteria, were included
in the study. The inclusion criteria of the study were:
(a) receiving hemodialysis treatment regularly for
FIGURE. Consort flow diagram.
Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
at least 6 months, (b) being capable of communicating
and having no problems of hearing and speech, (c)
aged between 18 and 65 years, (d) having no smelling
problem, (e) having no history of eczema, asthma,
herbal allergy, and so forth, (f) having no allergy to
lavender, (g) not diagnosed with psychiatric disorder,
and (h) to participating in the study voluntarily.
Intervention and intervention protocol
The researcher selected subjects by considering the
inclusion criteria, informing patients about the study
and obtaining written consent. The patients who
agreed to participate in the study were randomly
assigned to intervention and control groups (Figure).
The patients were taken from different sessions to
inhibit the interaction of lavender oil inhalation
between patients in intervention and control groups. In
the hospital where the study was conducted,
hemodialysis treatment was conducted in the morning
(8.00 AM to 12.00 PM) and the afternoon (12.00 PM to
4.00 PM) at a single HD unit. While the patients of the
intervention group in 8.00 AM to 12.00 PM session
were administered lavender oil, the patients of the
control group in 12.00 PM to 4.00 PM session did not
undergo any intervention.

It was decided to use lavender oil in the light of
literature information stating that it is the least toxic
and allergic among all aromatic oils, provides effective
relaxation, and has positive effects on fatigue and
anxiety via activation of the limbic system.11,16,18
Through a review of relevant literature, the application
route of lavender oil (inhalation),11,22,23 concentration
(2-mL lavender +98-mL water [2%]),18,24,25
intervention time (20 min), and the number of drops
(2 drops)23,24 were decided. Hundred percent pure
lavender oil was produced by the Awe-Cemre
Company (Izmir, Turkey). Given that pure lavender
oil is highly concentrated and can cause irritation,
the lavender oil was diluted with distilled water.25
The patients in the intervention group inhaled
lavender oil during the dialysis treatment for a total of
30 days (2 or 3 times a week). No application was
made to the control group.
Intervention protocol
Intervention group
On the initial day of the study, the questionnaire for
sociodemographic and disease characteristics, the
Fatigue Severity Scale (FSS), and the BAI were
completed by patients. The patients were undergoing
hemodialysis 2 or 3 days a week. The patients inhaled
2% lavender oil before hemodialysis when they came
to hemodialysis during these 2 to 3 days for 30 days.
Two drops of lavender oil were dropped on a 2 × 2 cm
gauze dressing, placed on the chest area of the
patients’ clothes (about 10-cm distance to the nose),
for a duration of 20 minutes, with direction to patients
to breathe normally.23,26 Fatigue level and anxiety of
the patients were evaluated by completing the fatigue
and anxiety scales again at the end of 30th day.
Control group
On the first day, the questionnaire for
sociodemographic and disease-related characteristics,
FSS, and BAI were completed by the patients included
in the study. The patients in this group underwent
routine care without the application of lavender oil.
Fatigue level and anxiety of the patients were evaluated
by completing FSS and BAI again at the end of 30th day.
Assessment instruments
Questionnaire for sociodemographic and disease
characteristics
This questionnaire was prepared by the researchers
in accordance with literature data in similar
Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Effect of Aromatherapy on Fatigue and Anxiety 225
studies.11,27 Sociodemographic data were collected
with a total of 6 questions including age, gender,
marital status, educational status, employment, and
social insurance, whereas the data on disease were
collected with a total of 5 questions involving duration
of chronic renal disease (CRD), hemodialysis period,
frequency of dialysis, stage of the disease, and the
presence of chronic disease other than chronic renal
failure.
Fatigue Severity Scale
Fatigue Severity Scale was developed by Krupp
et al28 to measure fatigue severity of patients with
multiple sclerosis. It is a Likert-type scale with 9
questions. Each question is scored between 1 (I
absolutely disagree) and 7 (I absolutely agree). Score
of the scale is the mean value of questions. A high
score shows increase of fatigue severity. Mean score
of 5 points and above is evaluated as “the existence of
fatigue.”28-30 Turkish version of the scale was applied
to patients with multiple sclerosis by Armutlu et al.30
Cronbach α coefficient was determined as 0.96 in the
study. It was also used to evaluate fatigue of patients
diagnosed with CRD who were undergoing
hemodialysis.7
Beck Anxiety Inventory
The BAI is a 4-point Likert self-assessment scale
developed by Beck et al.31 The scale was used to
identify frequency of anxiety symptoms experienced
by individuals. Each question is evaluated between 0
(never) and 3 (critically) and high scores indicate the
increase of anxiety complaints. Thus, the total score
obtained from the scale varies between 0 and 63. A
high total score indicates the severity of anxiety
experienced by the individual.31 Turkish validity and
reliability study of the scale was conducted by Ulusoy
et al,32 and Cronbach α coefficient of the scale was
calculated as 0.93. Thirteen items evaluate
physiological symptoms, 5 items reveal
comprehension, and 3 items indicate both somatic and
comprehension symptoms.32
Data analysis
The data of the study were evaluated using SPSS
21.0 (Statistical Package for the Social Sciences;
Chicago, Illinois) program. Chi-square analysis and
independent-samples t test were applied to compare
whether or not there were differences between
the intervention and control groups in terms of basic
226 HOLISTIC NURSING PRACTICE • JULY/AUGUST 2019

characteristics. Independent-samples t test was applied
to identify the difference between pretest-posttest
mean scores of intervention and control groups. Paired-
samples t test was applied to determine the difference
between pretest-posttest mean scores of the same group.
Ethical considerations
Written approval (ethics committee no.: 2017/64) was
obtained from Gaziantep University Şahinbey
Research and Application Hospital Ethics Committee
and the patients were informed about the study within
the scope of the declaration of Helsinki to conduct the
study and their written consents were obtained.
RESULTS
Sample characteristics
This study included a total of 60 patients: 30 patients
in the intervention group and 30 patients in the control
group. According to the study results, 17 (47.2%)
patients in the intervention group and 19 (52.8%)
patients in the control group were female. Mean age of
the patients was 55.76 ± 13.23 years in the
intervention group and 46.43 ± 14.23 years in the
control group. Also, 46.5% of the patients in the
intervention group and 53.5% of the patients in the
control group were married. Half of the patients in
both groups were primary education graduates. It was
found that 56.3% of the intervention group and 43.8%
of the control group had at least 1 comorbid disease.
The CRD duration of the intervention and control
groups was 90.33 ± 78.90 months and 73.53 ± 66.15
months, respectively. Hemodialysis duration of the
intervention and control groups was 53.80 ± 52.82
months and 43.86 ± 45.23 months, respectively. It
was determined that 47.8% of the patients in the
intervention group and 53.2% of the patients in the
control group underwent dialysis 3 times a week
(Table 1). There was no statistically significant
differences between the intervention and control
groups in terms of these characteristics (P > .05)
(Table 1). This indicated that both groups were

TABLE 1. Baseline Characteristics at Pretest Between Intervention and Control Groups

Group
Intervention Group Control Group Total Sample
(n = 30) (n = 30) (n = 60)
Variable n (%) n (%) n (%) Significance (P)

Age (mean ± SD), y 55.76 ± 13.23 46.43 ± 14.23 51.10 ± 14.41 − 2.630 (.054)a
Duration of ESRD (mean ± 90.33 ± 78.90 73.53 ± 66.15 81.93 ± 72.68 − 0.894 (.375)a
SD), mo
Total duration of hemodialysis 53.80 ± 52.82 43.86 ± 45.23 48.83 ± 49.01 − 0.782 (.437)a
(mean ± SD), mo
Gender
Male 13 (54.2) 11 (45.8) 24 (40.0) 0.792 (.278)b
Female 17 (47.2) 19 (52.8) 36 (60.0)
Marital status
Married 20 (46.5) 23 (53.5) 43 (71.7) 0.567 (.793)b
Single or divorced 10 (58.8) 7 (41.2) 17 (28.3)
Educational level
Illiterate 8 (57.1) 6 (42.9) 14 (23.3) 0.675 (.786)b
Primary education (8 y) 19 (50.0) 19 (50.0) 38 (63.3)
High school (4 y) 3 (37.5) 5 (62.5) 8 (13.3)
Presence of comorbidities
Yes 18 (56.3) 14 (43.8) 30 (50.0) 1.071 (.438)b
No 12 (42.9) 16 (57.1) 30 (50.0)
Frequency of dialysis (weekly)
2 times 8 (57.1) 6 (42.9) 30 (50.0) 0.542 (.373)b
3 times 22 (47.8) 24 (52.2) 30 (50.0)

Abbreviation: ESRD, end-stage renal disease; SD, standard deviation.

a
Independent t test.
b
Chi-square analysis.

Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.

homogenous. Although it was not indicated in Table 1,
it was determined that 93.3% of the patients
participating in the study had social insurance, 83.3%
were not employed, and all of them were in the end
stage of the disease.
Difference between FSS and BAI scores
of intervention and control groups
When FSS and BAI scores of the patients in control
and intervention groups before and after the
intervention were compared, the differences in the
change were found to be statistically significant in
favor of the intervention group (P < .05; Table 2).
In the intervention group, a statistically significant
difference was found between pretest-posttest FSS
(t = 7.177, P = .001) and BAI (t = 10.371, P = .001)
scores. Mean scores of FSS and BAI significantly
decreased following aromatherapy; in other words,
fatigue and anxiety levels declined (Table 2).
In the control group, there was no significant
difference between pretest-posttest scores of FSS (t =
−1.289, P = .208), whereas, a significant difference
was found between pretest-posttest scores of BAI
(t = −3.829, P = .001). Anxiety levels of patients in
control group increased at the end of 30 days (Table 2).
DISCUSSION
Aromatherapy, one of the complementary and
integrative practices commonly used in several
countries, is a substantial part of holistic nursing
practice. There are numerous studies in the literature
in which aromatherapy was applied with different
TABLE 2. Difference of FSS and BAI Scores Between Intervention and Control Groups at Pre- and Posttest
Intervention Group,
Scores Mean (SD)
FSS
Pretest 41.23 (8.51)
Posttest 35.23 (5.21)
Difference 6.00 (4.57)
tb = 7.177, P = .001
BAI
Pretest 49.43 (10.90)
Posttest 33.20 (9.45)
Difference 16.23 (8.57)
tb = 10.371, P = .001
Abbreviations: BAI, Beck Anxiety Inventory; FSS, Fatigue Severity Scale.
a
The score difference between experimental and control groups has been evaluated with the independent-samples t test.
b
The score difference between the pre and posttests of the same group was evaluated with the paired-samples t test.
Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Effect of Aromatherapy on Fatigue and Anxiety 227
sample groups.15,16,21,22 However the number of
studies evaluating the effect of aromatherapy on
fatigue and anxiety levels of patients undergoing
hemodialysis in Turkey is not sufficient.
In this study conducted with patients undergoing
hemodialysis, their fatigue level was found to decrease
after the administration of aromatherapy with lavender
oil. Fatigue of patients undergoing hemodialysis can
be associated with physical problems such as sleep
problems, depression, anemia, and therapy-related
problems (increased dependence, being connected to
the machine, etc). This symptom affecting life quality
of patients could be ameliorated with noninvasive and
evidence-based interventions effectively.20,33 Studies
conducted by Bagheri-Nesami et al,11 Muz and
Taşçı,20 and Biçer and Demir33 with patients
undergoing hemodialysis treatment, determined that
aromatherapy with lavender oil decreased fatigue
level.11,19,20,33 These studies are similar to the result
of the current study.
Anxiety is a complex phenomenon associated with
behavioral, psychological, physical, and mental
symptoms in dialysis patients.11,34,35 Changes in
marriage-family and social life; being dependent on
the dialysis machine, health care team, and family;
sexual dysfunction; and economic problems occurring
with hemodialysis treatment lead patients to suffer
from anxiety. Other long-term symptoms of disease
such as fatigue and sleep disorders are also important
factors increasing anxiety.11,18,19,34,35 In the literature,
it is indicated that increased anxiety in patients
undergoing hemodialysis may cause complications
such as overload and muscle cramps. Anxiety could
also negatively influence self-care and treatment
Control Group,
Mean (SD) Significance Testa (P)
37.60 (10.12) ta = − 1.504 (.138)
38.46 (9.12) ta = − 1.685 (.097)
− 0.86 (3.68)
tb = −1.289, P = .208
48.26 (12.29) ta = − 0.389 (.699)
49.76 (10.68) ta = 6.362 (.000)
− 1.50 (2.14)
tb = −3.829, P = .001
228 HOLISTIC NURSING PRACTICE • JULY/AUGUST 2019
regimen dependence of patients.34 Antidepressants
may cause some complications for patients undergoing
hemodialysis, these drugs may bond to proteins, do
not have a convenient renal clearance, and can
produce toxic metabolites. Therefore, complementary
practices are needed.11,34 When essential oils used in
aromatherapy are inhaled, several different molecules
contained in these oils are transferred to the limbic
system in the brain through the olfactory route in the
nose. Amygdale and hippocampus regions of the
limbic system are the most important regions
processing the aroma. Amygdale manages emotional
responses. Diazepam is known to decrease external
emotional stimuli by increasing inhibitory neurons
containing γ -aminobutyric acid in amygdala.15
Lavender is thought to have the effect of diazepam.
The limbic system provides sedative and relaxing
effect and reduces anxiety by interacting with the
cerebral cortex and affecting heart rate, blood
pressure, respiration, stress, and hormonal levels.15
The present study revealed that while anxiety levels of
the patients in intervention group decreased with a
statistically significant difference after aromatherapy,
anxiety level increased in control group. Numerous
studies conducted with patients undergoing
hemodialysis and other sample groups support the
result of the present study.15,19,21,22,34,35
LIMITATIONS
In this study, the short-term effect of lavender essential
oil has been evaluated. Therefore, the findings
obtained are valid for the short-term effect of lavender
essential oil on fatigue and anxiety. The results of this
study cannot be generalized because, 1 hemodialysis
unit was involved in the study. Moreover, another
limitation is that a placebo control group was not used
in this study.
CONCLUSION
This study revealed that aromatherapy applied with
lavender oil to patients undergoing hemodialysis
decreased fatigue and anxiety levels. Numerous
biopsychosocial complex problems of patients
undergoing hemodialysis cause them to experience
fatigue and anxiety and decrease their quality of life.
Hemodialysis nurses should routinely evaluate fatigue
and anxiety levels of patients. Hemodialysis nurses, as
Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
health care professionals in constant contact with
patients, can incorporate evidence-based practices
such as aromatherapy in their care management of
these symptoms. Lavender oil is an independent
nursing intervention, which has no side effects, is easy
to use, noninvasive, and cost-effective, and can be
applied to patients undergoing hemodialysis to ensure
symptom control.
IMPLICATIONS AND
RECOMMENDATIONS FOR PRACTICE
Based on insufficient number of studies on the effect
of lavender oil in Turkey, it is necessary to apply
lavender oil application in diverse and larger samples.
Therefore, there is a need for further randomized
controlled trials to be conducted on this matter.
Furthermore, by using different aromatic oils, the
results of the study can be enriched.
REFERENCES
1. Akyol AD. Hemodiyaliz hastalarında yaşam kalitesini etkileyen
faktörlerin incelenmesi. Nefroloji Hemşireliği Dergisi. 2016;11(1):
18-34.
2. Alemdar H, Pakyüz H, SÇ. Hemodiyaliz hastalarında öz bakım gücünün
yaşam kalitesine etkisinin değerlendirilmesi. Nefroloji Hemşireliği Der-
gisi. 2015;2(1):19-30.
3. Eggers PW. Has the incidence of end-stage renal disease in the
USA and other countries stabilized? Curr Opin Nephrol Hypertens.
2011;20(1):241-245.
4. Kara B. Ev hemodiyalizine yönelik inançlar ve deneyimler: güncel
kanıtların gözden geçirilmesi. Türk Nefroloji Diyaliz ve Transplanta-
syon Dergisi. 2016;25(1):17-23.
5. Süleymanlar G, Ateş K, Seyahi N. Renal replacement therapy in Turkey:
general consideration. In: Nephrology-Dialysis and Transplantation
in Turkey. Registry 2016. Ankara, Turkey: Türk Nefroloji Derneği
Yayınları; 2017:3-83.
6. Başaran D, Altun ÖŞ, Kaban F, Ecder T. Hemodiyaliz hastalarının
umutsuzluk düzeylerinin değerlendirilmesi. Nefroloji Hemşireliği Der-
gisi. 2016;1(1):10-17.
7. Karadag E, Kilic SP, Metin O. Relationship between fatigue and social
support in hemodialysis patients. Nurs Health Sci. 2013;15(2):164-171.
8. Usta YY, Demir Y. Hemodiyaliz hastalarında yorgunluğa etki eden
faktörlerin değerlendirilmesi. Anatol J Clin Investig. 2014;8(1):21-27.
9. Han SJ, Kim HW. Influencing factors on post-dialysis fatigue in
hemodialysis patients. IJUNESST. 2015;8(10):151-158.
10. Mohamed SA. The effectiveness of an educational intervention on fa-
tigue in hemodialysis patients: a randomized controlled trial. IOSR-
JNHS. 2014;3(4):40-50.
11. Bagheri-Nesami M, Shorofi SA, Nikkhah A, Espahbodi F, Ghaderi
Koolaee FS. The effects of aromatherapy with lavender essential oil
on fatigue levels in haemodialysis patients: a randomized clinical trial.
Complement Ther Clin Pract. 2016;22(1):33-37.
12. Erdoğan Z, Atik DÖ, Çınar S. Kronik böbrek yetmezliğinde tamam-
layıcı ve alternatif tıp yöntemlerinin kullanımı. Arşiv Kaynak Tarama
Dergisi. 2014;23(4):773-790.
13. Bagheri-Nesami M, Espahbodi F, Nikkhah A, Seyed SA, Charati JY.
The effects of lavender aromatherapy on pain following needle insertion

into a fistula in hemodialysis patients. Complement Ther Clin Pract.
2014;20(1):1-4.
14. Kavurmacı M, Tan M. Üremik kaşıntı ve aromaterapi uygulaması.
Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2014;3(1):674-682.
15. Ayik C, Özden D. The effects of preoperative aromatherapy massage on
anxiety and sleep quality of colorectal surgery patients: a randomized
controlled study. Complement Ther Med. 2018;36(1):93-99.
16. Fradelos E, Komini A. The use of essential oils as a complementary
treatment for anxiety. Am J Nurs Sci. 2015;4(2-1):1-5.
17. Kim M, Kwon YJ. Effects of aroma inhalation on blood pressure, pulse,
visual analog scale, and McNair scale in nursing students practicing
intravenous injection at the first time. J Adv Sci Technol. 2010;23(2):
61-68.
18. Karadağ E, Samancıoğlu S, Özden D, Bakır E. Effects of aromatherapy
on sleep quality and anxiety of patients. Nurs Crit Care. 2015;22(2):105-
112.
19. Paula D, Luis P, Olivia PR, Joao SM. Aromatherapy in the control of
stress and anxiety. Altern Integr Med. 2017;6(4):248.1-5.
20. Muz G, Taşcı S. Hemodiyaliz tedavisi alan bireylerde inhalasyon
yoluyla uygulanan aromaterapinin uyku kalitesi ve yorgunluk düzeyine
etkisi. Integr Tıp Derg. 2015;(2):110-111.
21. Karaman T, Karaman S, Dogru S, et al. Evaluating the efficacy of
lavender aromatherapy on peripheral venous cannulation pain and anx-
iety: a prospective, randomized study. Complement Ther Clin Pract.
2016;23:64-68. doi:10.1016/j.ctcp.2016.03.008.
22. Seifi Z, Beikmoradi A, Oshvandi K, Poorolajal J, Araghchian M, Safi-
aryan R. The effect of lavender essential oil on anxiety level in patients
undergoing coronary artery bypass graft surgery: a double-blinded ran-
domized clinical trial. Iranian J Nurs Midwifery Res. 2014;19(6):574-
580.
23. Hasanzadeh F, Kashouka N, Aminib S, et al. The effect of cold applica-
tion and lavender oil inhalatıon in cardiac surgery patients undergoing
chest tube removal. EXCLI J. 2016;15(1):64-74.
24. Chien LW, Cheng SL, Liu CF. The effect of lavender aromather-
apy on autonomic nervous system in midlife women with insomnia.
Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
View publication stats
Effect of Aromatherapy on Fatigue and Anxiety 229
Evid Based Complement Alternat Med. 2012;2012:740813. doi:10.
1155/2012/740813.
25. Yazdkhasti M, Pirak A. The effect of aromatherapy with lavender
essence on severity of labor pain and duration of labor in primiparous
women. Complement Ther Clin Pract. 2016;25:81-86.
26. Gedney JJ, Glover LT, Fillingim BR. Sensory and affective pain
discrimination after inhalation of essential oils. Psychosom Med.
2004;66(1):599-606.
27. Hashemi SH, Hajbagheri A, Aghajani M. The effect of massage with
lavender oil on restless leg syndrome in hemodialysis patients: a
randomized controlled trial. Nurs Midwifery Stud. 2015;4(4):e29617.
doi:10.17795/nmsjournal29617.
28. Krupp LB, Alvarez LA, LaRocca NG, Scheinberg LC. Fatigue in mul-
tiple sclerosis. Arch Neurol. 1988;45(4):435-437.
29. Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The Fa-
tigue Severity Scale. Application to patients with multiple sclerosis
and systemic lupus erythematosus. Arch Neurol. 1989;46(10):1121-
1123.
30. Armutlu K, Korkmaz NC, Keser I, et al. The validity and reliability of
the Fatigue Severity Scale in Turkish multiple sclerosis patients. Int J
Rehabil Res. 2007;30(1):81-85.
31. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measur-
ing clinical anxiety: psychometric properties. J Consult Clin Psychol.
1988;56(1):893-897.
32. Ulusoy M, Şahin NH, Erkmen H. Turkish version of the Beck Anxiety
Inventory: psychometric properties. J Cogn Psychother. 1998;12(1):
163-72.
33. Biçer S, Demir G. The effect of aromatherapy ınhalation on fatigue
level in ındividuals undergoing hemodialysis therapy. Int J Caring Sci.
2017;10(1):161-168.
34. Kiani F, Shahrakipour M, Zadeh MAH. The effect of inhaling lavender
on hemodialysıs patient’s anxiety. IJPT. 2016;8(2):13853-13865.
35. Bagheri-Nesami M, Shorofi SA, Nikkhah A, Espahbodi F. The effects
of lavender essential oil aromatherapy on anxiety and depression in
haemodialysis patients. Pharm Biomed Res. 2017;3(1):8-13.