KEYWORDS Clinical aromatherapy Clinical management Best practice model History Theoretic frameworks Plant sources Safety case reports Pathologic response KEY POINTS Aromatherapy is an alternative medicine or integrative therapy that works with conven tional medicine treatment.Aroma therapy emerged and was embraced as an alternative medicine for many medical a Mayo Clinic Hospital, Apheresis Department, 5777E Mayo Boulevard, Phoenix, AZ 85054, USA; b Austin Peay State University, School of Nursing, McCord Building, Clarksville, TN 37043, USA * Corresponding author.German HieronymusBraunschweigasurgeonandbotanist,wroteabookon distillationofoilsfromplantsthatincluded25oils France In1919,Gattefosse',afamouschemist,wasburnedinanexplosioninhis laboratory.Thewoundsbecameinfected.Woundrinsingwithessential oilseradicatedtheinfection.Hecoinedtheterm,aromatherapy,andwas knownforthemedicaluseofessentialoilswiththeirantibacterialand healingpropertiesofessentialoils.The National Institutes of Health National Center for Complementary and Integrative Health developed categories for these therapies--mind-body therapy, biologically based practices, manipulative and body-based practices, energy medicine, and whole med ical systems, suchasAyurvedicmedicine andtraditional Chinesemedicine.3,4 Nursing health care aromatherapy falls into the category of mind-body therapy.Clinical aromatherapy can be beneficial for symptom management for pain, nausea, vom iting, preoperative anxiety, critical care, well-being, anxiety, depression, stress, insomnia, respiratory, dementia, and oncology.E-mail address: farrarf@apsu.edu Nurs Clin N Am 55 (2020) 489-504 https://doi.org/10.1016/j.cnur.2020.06.015 nursing.theclinics.com 0029-6465/20/Published by Elsevier Inc.The US Consumer Product Safety Commission (CPSC) monitors unsafe products.11 The CSPC enforces federal laws to protect consumers against unreason able injury and death from products.12 The following are examples of how these 2 fed eral organizations monitor essential oils.Essential oils come from seeds, stems, leaves, needles, petals, flowers, rinds and fruits, woods and resins, roots and rhizomes, and grasses.Westerners found many alternative methods to treat medical conditions, such as pain, anxiety, depression, and insomnia,withscented oilsfromvarious plantsources.The pendulum began to swing from Western medication to an Eastern holistic approach.Table 1 sum marizes major historical timelines of countries and cultural influences, validating aromatherapy as medical, clinical, and holistic.REGULATION GUIDELINES FOR ESSENTIAL OILS The Food and Drug Administration (FDA) of the United States guidelines classify essential oils for aromatherapy as cosmetics, because they are not drugs for treating or prevention of a disease.10 Therefore, aromatherapy essential oils are not regulated by the FDA.Imbalancehaveillness Acupuncture,cupping,herbalteas,powdersfromplants,meditation,and herbalburningnearskin Greece TheophrastusinheritedthebotanicgardenfromAristotle.Hewroteabook aboutspecificusesandformulasforaromatics.Case reports are presented for considerations regarding flammability, elder and child safety, dermatitis, phototoxicity, oral toxicity, and eye safety, including critical analysis and intervention.Aromatherapy regulation of guidelines, plant sources for aromatic oils, and safe use of essential oils in symptom management in clinical aromatherapy is reviewed.According to the National Institutes of Health National Center for Complementary and Integrative Health, Americans spend more than $30.2 billion annually on this therapy.1 It is pre dicted the global market will grow in spending to $5 trillion by 2050.2 Aromatherapy also is called integrative medicine.3 It is especially important for frontline nurses to un derstand the difference between alternative therapy and integrative therapy.The outcome from the administration of essential oil can be measured with a pre anxiety level and post level of anxiety to determine if the essential oil is effective.4,5 WORLDWIDE HISTORICAL EVOLUTION OF AROMATHERAPY Aromatherapy has been used for thousands of years.NURSING THEORISTS SUPPORT FOR HEALTH CARE AROMATHERAPY Historical evolution of medical, clinical, and holistic uses of essential oils is embraced by 8 major nursing theorists.Their theoretic frameworks and concepts reflect the use of clinical aromatherapy as a patient-centered and holistic approach for balancing physical health, spiritual needs and well-being.Needtoregainbalancebyinternalpurificationsfollowedbyspecialdiet, herbalremedies,massagetherapy,yoga,andmeditation China ShenNung'smanuscriptlisted350plantsin2800BC.TheFoodandDrugAdministration ofthe UnitedStates guidelines classify essential oils as cosmetics because they are not drugs for treating or prevention of disease.Sadly, over time, opioids and antianxiety medications were abused, with the result of these medications purchased from drug dealers, overdosing, and death.Nursing health care uses essential oils to complement therapeutic interventions, decrease anxiety.Essential oils leaders emerged, sup porting aromatherapy as a credible therapy for mind, body, and spirit.Arabia IbnSina,anArabicphysician,usedaromatics,suchassenna,camphor,and cloves,formedicaltreatment.It was common for pain to be treated with various levels of opioids and receiving prescriptions for medications with each physician visit.Yoga, Pilates, mindfulness meditation, acupuncture, and scented oils were used with massage.In alter native medicine, the therapy works as an addition to conventional medical treatment, whereas integrative therapy is solo and replaces any conventional medical care.Table1 Historicalevolution Country CulturalTherapy Egyptian culture Resins,balms,andfragrantoils PapyrusEberswroteafamousmanuscriptaboutaromaticmedicine.ThefirstprivateapothecaryshopopenedinBaghdad.withdispensing medicines.suchastinctures,suppositories, inhalants,andpills.It is expected that the plant-based essential oil applications can be measured, such as a preanxiety symptoms, interventions with essential oil, and postanxiety symptoms.Hippocrates, father of modern medicine, advocated the use of aromatherapy due to his belief that aromatic baths and scented massage were key to good health.The 8 theorists' embracement con firms health care aromatherapy is a credible alternative method (Table 2).Kyphiformulacontained16plantsandwasusedforsleepandanxiety,to sootheskin,andasanantidoteforsnakebite.Hebecamethefatherof botany.Credibility is seen in the historical evolution and nursing theorist support.INTRODUCTION The Western perspective on health care has been focused on medications for treat ment of health care conditions.Suggestions are recommended for a best practice model for clinical aromatherapy.CLINICAL AROMATHERAPY Aromatherapy is a fast-growing complementary therapy worldwide.Iraq Askeletonwasfound30,000yearsagowithconcentrationofextractedplant essentialoils.TraditionalChinesemedicine Basedonharmonyenergyofyin-yang Oppositesbalanceiskeytohealth.The federal government and states stepped in, passing laws monitoring prescriptions written for opioids; therefore, a search for alternative medicine began.This article investigates the use of clinical aromatherapy.India TheAyurvedanaturalsystemofmedicinewasbasedondiseaseduetoan imbalanceofstressinaperson'sconsciousness.PedaniusDioscorideswroteDeMateriaMedicacovering700plants, includingaromatics.Roseororangeblossomwasusedasflavortomedicine.Thisledtothe manufacturingofmedicine.JeanValnet,anarmyphysician,wrotethefirstaromatherapybookbya doctor.Alternative methods were found in the Eastern perspective on health care.Thisisbelievedtobearound2800BC.Indianshamansareknownasperfumeros,fromscentsofplants.Hippocrateswroteaboutaromaticbathsandantibacterialpropertiesand urgedpeopletocarryaromaticplantsforprotection.Inhaledhenbanewasusedasanesthetic.Topicalsugarwasusedtostop bleeding.490 Farrar & Farrar conditions.Ayurvedicphysiciansarecalledholymen.Chineseculturestillembracesherbalmedicine.Pre-Christianeraemergedwiththebeliefthatessentialoilswerepagan.In response,PopeGregorytheGreatpassedalawbanningallaromatics.WorksofGalenandHippocratesweresmuggledtoSyriaforsafekeeping.Medicalaromatherapyemergedinthethirdcentury.ShirleyPriceauthoredAromatherapyforHealthcareProfessionals.Sheis knownforclinicaluseofessentialoils.