Introduction
The surgical process is always accompanied by some kind of overt/covert or natural/unnatural emotional reactions. One of the most common problems of patients before surgery is psychological disorders such as anxiety, stress and depression. According to Shauly et al.’ [4] study, about 57.84% of patients suffer from anxiety in the pre-operative stage. The main goal of pre-surgery care is to improve the physiological and psychological health of the patient. In general, two types of pharmaceutical and non-pharmacological methods are used to reduce the level of anxiety and stress in patients. Today, the acceptability of complementary and non-pharmacological treatments has increased. Aromatherapy is one of the non-pharmacological methods and the second complementary medicine method among nurses, which is the mostly used in bedside. One of the types of scents that has a relaxing effect and is used a lot is the rosemary essential oil. Considering the ease of applying aromatherapy compared to other alternative treatment methods such as acupuncture and hypnosis, we decided to conduct this study with the aim of determining the effect of aromatherapy using rosemary essential oil on the pre-operative levels of anxiety, stress, depression and physiological indicators in candidates for general surgery.
Methods
The sample size was calculated 60 based on previous studies and considering a type 1 error of 0.05 and a test power of 0.80. The samples were randomly divided into two aromatherapy (n=30) and control (n=30) groups. The data collection tools were a demographic form, the 21-item depression anxiety stress scale (DASS-21), and a checklist for recording vital signs. Questionnaires were completed by the researcher through interview immediately after hospitalization. In the aromatherapy group, one hour before going to the operating room, 3 drops of 10% rose essential oil were poured on a tissue and pinned to the patient’s pillow, and the patients were asked to smell it for 20 minutes. In the control group, patients received routine nursing care before surgery. One hour after the implementation of the intervention and before the surgery, the questionnaires were completed again by the researcher. The collected data were analyzed in SPSS software, version 21. The significance level was set at 0.05.
Results
The results of chi-square test did not show statistically significant differences between the study groups in demographic characteristics (P>0.05). The results of paired t-test showed that aromatherapy was significantly effective in reducing anxiety, stress and depression of patients before surgery (P<0.05) (Table 1).


Discussion
According to the results of the study, aromatherapy with rosemary essential oil can reduce the level of anxiety, stress, depression and improve some physiological indicators of patients before surgery. Therefore, it is recommended to use it along with modern medicine.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of Shahrekord University of Medical Sciences (Code: IR.SKUMS.REC.1396.264 ). All ethical principles were considered in this study.

Funding
This study was extracted from a research proposal approved by Shahrekord University of Medical Sciences. 

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors would like to thank Shahrekord University of Medical Sciences for their financial support and the personnel of the surgical departments of Shahid Kashani Hospital for their cooperation.

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