INTRODUCTION

Chronic kidney disease is a significant health problem worldwide, and its main treatment is hemodialysis and, ultimately, kidney transplantation (Valehi et al.,2019). The prevalence of preoperative anxiety varies depending on the type of surgery, gender, and reasons for surgery (Chekole et al., 2020). Nowadays, there are many pharmacological and non-pharmacological methods for controlling anxiety. One of the most extensively used herbal medicines native to Iran is Citrus aurantium (Moslemi et al., 2019). Hospitalization and surgery are considered negative life events that can cause significant levels of anxiety (Chekole et al., 2020). Bitter orange affects the activity of the central nervous system and can have sedative and antidepressant effects (Moslemi et al., 2019). Since no study has been found on the anxiety of patients undergoing central venous catheterization for hemodialysis, the present study was conducted to investigate the effect of inhaling the aroma of Citrus aurantium on the anxiety levels of patients undergoing central venous catheterization for hemodialysis.
METHODS
The present study was a clinical trial conducted on 60 patients referred to Labafinezhad Hospital in Tehran, Iran, in 2024. Participants were randomly divided into two groups of 30 (test and control) with informed consent. In the experimental group, Citrus aurantium perfume, manufactured by Adonis Gol Darou Company (Tehran, Iran), with a concentration of 10%, was employed. The amount of perfume used was three drops on sterile gauze, placed on the patient's clothes at a distance of 7 to 10 cm from the patient. The inhalation time was 20 minutes, administered before catheterization. In the control group, three drops of water were used as a placebo for the same 20 minutes. Data were collected using a demographic questionnaire and the Spielberger Standard Anxiety Questionnaire.
The Kolmogorov-Smirnov test and Levene's test were employed to determine the normality of the research variables and to equalize variances, respectively. A paired t-test was applied to compare the mean anxiety scores before and after the intervention, and an independent samples t-test was used to compare the mean anxiety scores after the intervention in the two experimental and control groups. Data analysis was performed using SPSS (Version 27) software. The significance level was set at 0.05.
RESULTS
Both test and control groups had no statistically significant differences at the 95% confidence level and were homogeneous in terms of gender, marital status, education, insurance, surgical history, and duration of illness.
The age of most patients in the experimental group (33.3%) was between 31 and 43 years, while the age of the control group (43.3%) was between 57 and 69 years.
The mean and standard deviation of age in the intervention and control groups were 22.44±1.63 and 28.88±1.72, respectively. Most of the participants in the study (55%) were male.
The mean total anxiety scores of patients before the intervention were 77.43±6.70 in the intervention group and 76.67±5.43 in the control group, which was not statistically significant. After the intervention, the score reached 71.70±6.61 in the intervention group and 76.20±5.21 in the control group, and this difference was significant in the intervention group (p<0.05).
CONCLUSION
The scent of Citrus aurantium has been shown to have a beneficial effect on reducing anxiety in patients undergoing central venous catheterization for hemodialysis. The present intervention, as confirmed, is feasible, useful, effective, and inexpensive, and can be included in the agenda of caregivers, especially nurses. Nursing managers can take an effective step towards satisfaction and effectiveness of medical care by teaching this method to nurses and supervising their work.
Ethical Considerations
Compliance with ethical guidelines
The present study is derived from a master's thesis in nursing from Tehran Islamic Azad University of Medical Sciences, Iran, with ethics code IR.IAU.TMU.REC.1403.171 and Iranian clinical trial with code IRCT20240712062405N1. The principles of the Declaration of Helsinki, including obtaining informed consent from participants and confidentiality of their information, were observed.
Funding
There is no funding support.
Authors’ Contribution
All authors contributed equally to the conceptualization and writing of the article. The authors also approved the content of the manuscript and agreed on all aspects of the work.
Conflict of Interest
The authors declare that they have no conflicts of interest.
Acknowledgments
We would like to express our sincere appreciation and gratitude to all the patients who participated in this study and to all the loved ones who accompanied us during this research.