Acceptance and normalization of aromatherapy in emergency department rest areas: a mixed-methods study using Normalization Process Theory.

OBJECTIVE: To examine factors associated with emergency department nurses' acceptance of aromatherapy interventions in rest areas and to explore the internal relationships among core mechanisms of Normalization Process Theory (NPT). METHODS: An explanatory sequential mixed-methods design was employed. In Phase I, a cross-sectional survey was conducted among 601 emergency department nurses from 30 tertiary Grade A hospitals across multiple regions in China. An NPT-informed acceptance questionnaire was developed, and its structure was refined into a 19-item model using exploratory factor analysis (development sample, n = 300) and confirmatory factor analysis (validation sample, n = 301). Exploratory path analysis was then performed in the full sample (n = 601). In Phase II, 18 nurses were purposively selected based on quantitative findings for semi-structured interviews. Thematic analysis was used to contextualize and explain the quantitative results. RESULTS: A total of 601 nurses were included. The mean acceptance score was 73.74 ± 12.07 (95% CI: 72.77-74.71), indicating a moderately high level of acceptance. In univariate analyses, educational level, job role, allergy history, chronic respiratory conditions or odor sensitivity, and odor-related discomfort in the past year were associated with acceptance (all p < 0.05). In multiple regression analysis, higher night shift frequency (β = -0.128, p = 0.003), absence of a definite allergy history (β = 0.118, p = 0.006), and no odor-related discomfort in the past year (β = 0.178, p < 0.001) remained independently associated with acceptance. Split-sample validation demonstrated that the revised 19-item model provided a better fit than the initial 23-item five-factor model and showed good fit in the full sample. Path analysis revealed theory-consistent positive relationships from coherence to cognitive participation and reflexive monitoring, which in turn predicted collective action. Perceived barriers were negatively associated with collective action (all p < 0.001). Model fit was acceptable. CONCLUSION: Emergency department nurses demonstrated a moderately high level of acceptance of aromatherapy interventions in rest areas. This study provides preliminary evidence on the interrelationships among core NPT mechanisms and identifies perceived barriers as an independent constraint on collective action. Given the cross-sectional design and the use of a single dataset for both model refinement and path analysis, these findings should be interpreted as exploratory. It is important to note that this study assessed acceptance as an implementation outcome and did not evaluate the clinical effectiveness of aromatherapy.