Effect of inhalation aromatherapy using damask rose essential oil on students' exam anxiety and performance: A multi-center, randomized, placebo-controlled study.

Background: Objective structured clinical examination (OSCE) is growingly implemented in perioperative nursing courses. However, most students experience significant OSCE-associated anxiety, which can negatively affect their exam performance. Hence, we compared the effects of inhalation aromatherapy by placebo and damask rose on the operating room (OR) students' anxiety and performance in five OSCE stations run for summative evaluation of basic perioperative practices.

Materials and methods: This multi-center, randomized, placebo-controlled study was performed among 52 first-year undergraduate OR students during the academic year 2022-2023 at three universities in Khuzestan Province, Iran. Through the stratified randomization approach, students were allocated into two groups: placebo (n = 26) and damask rose (n = 26). Before initiating OSCE stations, the students inhaled two droplets of placebo (paraffin oil) or damask rose essential oil for 15 min in the exam quarantine room. Students completed the Spielberger's State-Trait Anxiety Inventory for state anxiety at three endpoints: T1) immediately after admission to the exam quarantine room (baseline), T2) immediately at the end of the 15-min aromatherapy, and T3) immediately after completion of all OSCE stations. Also, a blinded rater completed a checklist to evaluate the student's performance in each OSCE station. Data were analyzed in the Statistical Package for Social Sciences software, using the Mann-Whitney U, Friedman's one-way repeated measures analysis of variance, and the Wilcoxon signed-rank tests.

Results: The mean anxiety scores were significantly lower in the damask rose group in comparison to the placebo group at both T2 and T3 (P < 0.001 and P = 0.001, respectively). Similarly, students in the damask rose group performed perioperative practices in two OSCE stations significantly better than those in the placebo group (P < 0.001).

Conclusion: Aromatherapy with damask rose could be potentially valuable in alleviating OR students' pre- and post-OSCE anxiety and improving their performance during the OSCE. Therefore, given that this traditional and integrative intervention is low-cost and easy to use, it could be applied in educational programs to reduce OR students' OSCE-associated anxiety and improve their basic perioperative skills. However, additional investigations are required to identify the sustainability of the results.