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, 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 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.