Lemon Essential Oil in Reducing Test Anxiety
Phase: NA
Conditions: Nursing Student
Sponsor: Ataturk University

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Effectiveness of Lemon Essential Oil of Aromatherapy in Reducing Test Anxiety in 
Nursing Students 
Document Date: 01.01.2020 
 
Methods 
Context and Characteristics: A randomized, pre-test-post-test design was carried out to 
examine the effectiveness of lemon essential oil in reducing test anxiety in first-year students 
of the Faculty of Medical Sciences of a private university in Istanbul. 
Universe and Sample: The universe of the study consists of first-year students of the Faculty of 
Medical Sciences of a private university in Istanbul (N=54), with active registration records at 
the university as of January 2020. 
The sample included students who met the inclusion criteria (N=48) from among the students 
who agreed to participate in the study after it was announced. The randomisation of the study 
sample group was conducted through block randomisation. In the study, since the student names 
are available in the class lists, students are randomly assigned to the groups using the numbers 
table in this list with the help of the computer. The blocks were randomly selected and this 
procedure continued until all subjects to be included in the study were assigned to the groups. 
At the end of this procedure, the number of students in the groups was equalized and twenty-
four 
students 
each 
were 
assigned 
to 
the 
intervention 
and 
control 
groups.  
Since two of the students in the intervention group did not want to participate in the study, they 
left the study without handing in their pre-test forms. 
Inclusion and Exclusion Criteria: The inclusion criteria included not having a respiratory 
system disease (asthma, flu, etc.), known allergic reaction to the essential oil to be used, allergy 
to any smell, pregnancy, epilepsy, inability to smell or inhale, not using any medication that 
might affect heart rate and blood pressure, not practicing other complementary medical 
practices (yoga, meditation, aromatherapy, massages, etc.), volunteering to participate in the 
study.10-12 Students determined to have an anxiety disorder, disease, allergic reaction in 
question, a recent stressful history or a disability condition that is thought to be effective on the 
results of the study were excluded in the study. 
Data Collection Tools 
The data were collected through the personal information form, State Test Anxiety Scale 
(STAS) and Test Anxiety Schedule (TAS). 
Personal Information Form 

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The personal information form contained nine questions on age, gender, education level, 
profession, place of residence, socio-economic status and success level at school (According to 
the grade point average).  
Test Anxiety Scale (TAS)  
Developed by Bozkurt (2019), the scale evaluates the degree of anxiety students feel before a 
test on a scale of 0 to 10. A score of 0 indicates no anxiety, while a score of 10 indicates severe 
anxiety.35  
State Test Anxiety Scale 
Developed by Şahin in 2019, this scale determines students’ anxiety levels before a test. It is a 
4-point Likert-type scale consisting of three sub-dimensions and 22 items. The cognitive 
dimension consists of nine items (3, 4, 7, 9, 14, 16, 18, 20, 22), wherein the lowest possible 
score is nine and the highest score is 36. The psychosocial dimension consists of five items (6, 
10, 12, 13, 21), wherein the lowest possible score is 5 and the highest score is 20. The 
physiological dimension includes eight items (1, 2, 5, 8, 11, 15, 17, 19), wherein the lowest 
possible score is 8 and the highest score is 32. Possible scores on the scale ranged between 22 
and 88. There were no reverse items on the scale. A high score on the sub-dimensions and the 
whole scale indicates high level of anxiety. Cronbach’s alpha coefficients of the scale were 0.93 
for the cognitive sub-dimension, 0.84 for the psychosocial sub-dimension, 0.85 for the 
physiological sub-dimension and 0.94 for the whole scale.3 Cronbach’s alpha coefficient in this 
study was 0.78 for the cognitive sub-dimension, 0.82 for the psychosocial sub-dimension, 0.87 
for the physiological sub-dimension and 0.91 for the whole scale. 
Application of Data Collection Tool 
The study was carried out prior to an anatomy examination, which was the most concerning for 
the students according to their expressions. The pretest personal information form, STAS 
and TAS data collection tools were administered to all students in the study in a different exam 
room. Students in the control group were taken to the exam room prepared for them and were 
told that there would be no study application other than administering the data collection forms. 
Anything related to aromatherapy that can affect the process was not told to the students. Next, 
students in the intervention group who agreed to participate in the study were informed about 
the aromatherapy method to be used. Students in the intervention group were taken to the exam 
room specially prepared for them. After waiting for 15 minutes in the exam room for the 
aromatherapy administered through inhalation to take effect in the intervention group, the post-
test STAS and TAS data collection tools were administered.  

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There was no intervention for the students in the control group. The study was carried out on 
the basis of the application made at the universities during the exam periods of the students. At 
the universities where the students study, 15 minutes before the exam, the students are taken to 
the class, the seating arrangement is provided and information is given about the exam rules. 
This is a standard practice for all students. Since the study was conducted according to this 
application, after waiting 15 minutes in the exam hall, post-test STAS and TAS data collection 
tools were administered.  
Intervention 
The exam rooms were cleaned and adequately ventilated before the administration. Students in 
the intervention and control groups were taken to two separate exam rooms with the same size 
and physical features. The intervention group was placed in a classroom where the doors and 
windows were shut 30 minutes prior to the test, and an oil diffuser was placed to diffuse the 
fragrance. The oil diffuser was placed 30 cm away from the students, and five (5) drops of 
essential lemon essential oil (diluted with 100cc distilled water) were placed inside the diffusing 
chamber. To ensure homogeneity of the fragrance in the air, the diffuser was activated 15–20 
minutes before the intervention group was taken to the exam room. Furthermore, three drops 
of lemon essential oil were applied to non-absorbent napkins before the students were taken to 
the exam room. These napkins were placed on the students’ collars, and the intervention group 
was taken to the examination hall. Students in the intervention group were asked to inhale the 
lemon essential oil in the examination hall for 15 minutes.10-12 Students are admitted to the class 
15 minutes before the exams in the practice carried out during the exam period at the university 
where the research is conducted. In the study, a 15-minute application period was determined 
by taking both the relevant studies and this exam application.  
Fifteen minutes later, the STAS and TAS data collection tools were administered to 
the intervention group. The data collection tools took approximately five minutes to fill out, 
and the researchers recollected them after completion. After the data collection tools were 
retrieved, the oil diffuser and napkins placed on the students’ collars were removed from the 
exam room, following which the test commenced. 
To prevent cross-contamination, the students in the control group were taken to a cleaned and 
ventilated exam room located away from the students in the intervention group. After waiting 
for 15 minutes in the exam room, STAS and TAS data collection tools were administered. The 
data collection tools took approximately five minutes to fill out, and the researchers recollected 
them after completion, following which the test commenced. Lemon essential oil was used as 
the aromatic oil in this study administration.  

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 Variables  
The independent variable in this study was lemon essential oil, and the dependent variables 
were STAS and TAS. Lemon essential oil was obtained from a company that has safety, quality 
and approval certificates from the Turkish Ministry of Health. This oil, which does not contain 
any artificial preservatives, is derived from lemon peels using the mechanical process of cold 
pressing. 
Data Analysis 
The descriptive statistics were shown through numbers and percentages, while the pretest and 
post-test data were shown through mean scores and standard deviation values in the analysis of 
the data. The Wilcoxon test, Student T-test, Mann Whitney U-test and Spearman’s correlation 
analysis were used. A simple linear regression analysis was used to determine the effect of the 
independent variable on the dependent variable. The data were analysed on a computer 
using SPSS 22. The statistical significance level was set as p<0.05. 
Ethical Dimension 
An approval (No. 2020/1) was obtained from the Ethics Committee of the University where the 
study was conducted, and written permission was obtained from the institution where the study 
would be carried out. Moreover, written and verbal consent was obtained from the participants 
after explaining the purpose of the study. The written permission was also obtained from the 
researcher who conducted the Turkish validity and reliability study of the scale.